Patient-Centered Facial and Orofacial Reconstruction After Cutaneous Cancer Resection: Integrating Function, Aesthetics, and Quality of Life
DOI:
https://doi.org/10.64784/313Palabras clave:
facial reconstruction, orofacial reconstruction, skin cancer, oncologic resection, Mohs surgery, local flaps, skin grafts, microvascular reconstruction, functional outcomes, aesthetic outcomes, quality of life, patient-reported outcomesResumen
Facial and orofacial reconstruction following cutaneous oncologic resection represents a complex clinical challenge in which tumor control must be integrated with preservation of function, restoration of facial appearance, and maintenance of quality of life. This study analyzed contemporary reconstructive strategies used after facial skin cancer excision, with emphasis on the relationship between defect characteristics, anatomical location, surgical technique, functional recovery, aesthetic integration, postoperative complications, and patient-reported outcomes. A structured review was conducted under the Scientific Method framework, incorporating clinical guidelines, systematic reviews, observational studies, reconstructive case series, and investigations focused on patient-reported outcomes. The findings showed that reconstructive success depends primarily on individualized surgical planning rather than on the superiority of a single technique. Primary closure, skin grafts, local flaps, regional or staged flaps, and microvascular free-tissue transfer provide different advantages according to defect size, depth, tissue involvement, and functional requirements. Nasal reconstruction requires preservation of airway patency and structural support; periocular reconstruction prioritizes ocular protection and eyelid closure; and lip and perioral reconstruction requires maintenance of oral competence, speech, and feeding. The evidence also demonstrated that flap survival and wound healing alone are insufficient to define successful reconstruction. Aesthetic integration, complication burden, patient satisfaction, psychological well-being, and social reintegration must also be considered. Patient-reported outcome measures, including the FACE-Q Skin Cancer Module, strengthen the assessment of reconstructive effectiveness. Overall, the evidence supports a multidimensional and patient-centered approach in which oncologic safety, function, aesthetics, and quality of life are balanced to achieve comprehensive recovery after facial and orofacial cancer surgery.
Referencias
• Zimmer, D. I., Wieland, A. M., & Ku, J. A. (2023). Reconstruction after skin cancer resection of the head and neck. Otolaryngologic Clinics of North America, 56(4), 779–790. doi:10.1016/j.otc.2023.04.006.
• Desisto, N. G., Ortiz, A. S., Yang, S. F., Stephan, S. J., & Patel, P. N. (2023). State of the evidence for facial skin cancer reconstruction. Facial Plastic Surgery, 39(3), 220–229. doi:10.1055/a-2008-2798.
• Chen, A., Albertini, J. G., Bordeaux, J. S., Chen, M. W., Cook, J. L., Davidson, C., Donnelly, K. C., Galaria, I. I., Hannan, C. M., Kantor, J., Kapp, D. L., Lawrence, N., Lober, C. W., Loeding, L. D., Miller, A., Ness, D. T., Neves, R. I., Revenaugh, P. C., Setabutr, P., … Alam, M. (2021). Evidence-based clinical practice guideline: Reconstruction after skin cancer resection. Journal of the American Academy of Dermatology, 85(2), 423–441. doi:10.1016/j.jaad.2021.03.015.
• Egeler, S. A., Johnson, A. R., Ibrahim, A. M. S., Bucknor, A., Chen, A., Malyar, M., Tobias, A. M., Lin, S. J., Mureau, M. A. M., & Lee, B. T. (2019). Reconstruction of Mohs defects located in the head and neck. Journal of Craniofacial Surgery, 30(2), 412–417. doi:10.1097/SCS.0000000000005137.
• Johnson, A. R., Egeler, S. A., Wu, W. W., Bucknor, A., Ibrahim, A. M. S., & Lin, S. J. (2019). Facial reconstruction after Mohs surgery: A critical review of defects involving the cheek, forehead, and perioral region. Journal of Craniofacial Surgery, 30(2), 400–407. doi:10.1097/SCS.0000000000005074.
• Losco, L., Bolletta, A., Pierazzi, D. M., Spadoni, D., Cuomo, R., Marcasciano, M., Cavalieri, E., Roxo, A. C., Ciamarra, P., Cantisani, C., & Cigna, E. (2020). Reconstruction of the nose: Management of nasal cutaneous defects according to aesthetic subunit and defect size. A review. Medicina, 56(12), 639. doi:10.3390/medicina56120639.
• Halani, S. H., Ma, C., Pierce, J., Sanniec, K., & Thornton, J. F. (2021). Nasal reconstruction after Mohs cancer resection: Lessons learned from 2553 consecutive cases. Plastic and Reconstructive Surgery, 148(1), 171–182. doi:10.1097/PRS.0000000000008098.
• Sanniec, K., Malafa, M., & Thornton, J. F. (2017). Simplifying the forehead flap for nasal reconstruction: A review of 420 consecutive cases. Plastic and Reconstructive Surgery, 140(2), 371–380. doi:10.1097/PRS.0000000000003540.
• Alexander, N. A., Enin, K., Ji, J., & Spataro, E. (2025). Functional and aesthetic outcomes of post-Mohs nasal reconstruction. Craniomaxillofacial Trauma & Reconstruction, 18(1), 17. doi:10.3390/cmtr18010017.
• Wang, M. R., Menville, J. E., Shinde, N., Griffin, F. S., Kite, A. C., & Woo, A. S. (2025). Aesthetic outcomes of nasal reconstruction following Mohs excision. Annals of Plastic Surgery, 94(4S Suppl 2), S263–S270. doi:10.1097/SAP.0000000000004211.
• Sanniec, K., Harirah, M., & Thornton, J. F. (2020). Lip reconstruction after Mohs cancer excision: Lessons learned from 615 consecutive cases. Plastic and Reconstructive Surgery, 145(2), 533–542. doi:10.1097/PRS.0000000000006509.
• Archibald, L. K., Gupta, R., Shahwan, K. T., Swick, M. E., Bakker, C., Mattox, A. R., Alam, M., & Maher, I. A. (2023). Periorbital reconstructive techniques following Mohs micrographic surgery or excisions: A systematic review. Archives of Dermatological Research, 315(7), 1853–1861. doi:10.1007/s00403-022-02523-z.
• Patel, S. Y., & Itani, K. (2018). Review of eyelid reconstruction techniques after Mohs surgery. Seminars in Plastic Surgery, 32(2), 95–102. doi:10.1055/s-0038-1642058.
• Taibo, A., & Cabrera-Sarmiento, J. A. (2025). Optimizing facial reconstruction of skin cancer defects with combined local flaps. Journal of Craniofacial Surgery, 36(8), e1222–e1224. doi:10.1097/SCS.0000000000011437.
• Lee, E. H., Klassen, A. F., Cano, S. J., Nehal, K. S., & Pusic, A. L. (2018). FACE-Q Skin Cancer Module for measuring patient-reported outcomes following facial skin cancer surgery. British Journal of Dermatology, 179(1), 88–94. doi:10.1111/bjd.16671.
• Dobbs, T. D., Ottenhof, M., Gibson, J. A. G., Whitaker, I. S., & Hutchings, H. A. (2021). The Patient-Reported Outcome Measures In Skin Cancer Reconstruction (PROMISCR) study: Anglicisation and initial validation of the FACE-Q Skin Cancer Module in a UK cohort. Journal of Plastic, Reconstructive & Aesthetic Surgery, 74(3), 615–624. doi:10.1016/j.bjps.2020.09.005.
• Blank, N. R., Giordano, C. N., Dusza, S., Nehal, K., & Lee, E. H. (2020). Patient expectations influence postoperative facial satisfaction measured by the FACE-Q Skin Cancer Module: A pilot study. Dermatologic Surgery, 46(8), 1113–1115. doi:10.1097/DSS.0000000000002014.
• Dey, J. K., Ishii, L. E., Byrne, P. J., Boahene, K. D. O., & Ishii, M. (2015). The social penalty of facial lesions: New evidence supporting high-quality reconstruction. JAMA Facial Plastic Surgery, 17(2), 90–96. doi:10.1001/jamafacial.2014.1131.
• Dey, J. K., Ishii, M., Boahene, K. D. O., Byrne, P., & Ishii, L. E. (2015). Impact of facial defect reconstruction on attractiveness and negative facial perception. The Laryngoscope, 125(6), 1316–1321. doi:10.1002/lary.25130.
• Gosselin, L.-E., Villemure-Poliquin, N., & Audet, N. (2024). Quality of life after head and neck cancer surgery and free flap reconstruction: A systematic review. Journal of Otolaryngology–Head & Neck Surgery, 53, 19160216241248666. doi:10.1177/19160216241248666.
