Large facial malignant tumor defect reconstruction using keystone flap: a case report

Background: Facial defects resulting from a large malignant tumor excision are often too extensive for primary closure, necessitating the use of skin flaps or grafts. The challenge is particularly pronounced when the defects occur in the facial region. Deciding how to reconstruct facial defects involves considering various factors, with aesthetics taking precedence over other body parts. The preferred method for closing these defects is ideally by transposing local tissues with similar qualities, especially in cases where primary closure is not feasible due to the size of the defect. Case presentation: A case report study of a 60-years-old female patient referred to H. Adam Malik Hospital and underwent excision of malignant tumor and left with large defect on the right cheek and 2/3 upper & 1/3 lower vermillion. Skin flap techniques, such as the advancement flap, rotation flap, and transposition flap, are useful for closing small defects. When dealing with moderate to large-sized defects, especially in high-tension areas, a combination of flap types may be necessary. Over the past two decades, pedicled perforator flaps, notably the keystone flap design, have gained popularity as a viable option. Understanding facial aesthetic units, subunits, and factors influencing incision/scar placement is crucial for clinicians aiming to achieve the most cosmetically pleasing outcome. Conclusions: The presented case details the successful closure of a sizable cheek defect post squamous cell carcinoma excision surgery, achieved through the utilization of a KPIF Type IIA. Patient showed good flap survival.