Local flap reconstruction of defects after excision of nonmelanoma skin cancer.

Reconstruction of facial defects poses the interesting challenge of finding the most satisfactory flap both aesthetically and functionally. It requires not just a knowledge of the flap, but an ability to think and plan in three dimensions. Not all individuals possess this; thus, what is obvious and simple to one surgeon, poses a great and worrisome problem for another. This can be made easier by considering certain rules. First, excise the lesion properly and then think about the reconstruction. The presence of the defect crystallizes the thought process. Next, consider the topographic and functional anatomy of the face, the differences in skin color, presence of hair, and the "idea" lines for position of scars. The flap options are rotation, transposition, and advancement. The latter, on occasions, may be as an island. These movements must be fitted into the aforementioned requirements. In this way the best choice usually is reached. Remember, there is always a way out using a skin graft or tissue expansion.