Versatility of Cheek Rotation and Advancement Flaps in Multizonal Facial Reconstruction

Objective: To systematically assess the versatility, safety, and results of cheek rotation and advancement flaps after BCC excision, focusing on indications, techniques, complications, and outcomes to refine reconstructive strategies in facial plastic surgery. Study Design: Retrospective study Place and Duration of Study: This study was conducted at the Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan from June 2020–March 2024. Methods: This retrospective study evaluated 18 patients (mean age 56.1 years; range 40–75) with facial defects from BCC excision, treated using cheek rotation, advancement, or combined flap techniques by a single surgeon. Patient demographics, comorbidities, defect characteristics, and outcomes were reviewed from medical and photographic records. Results: All patients were followed for 6 months to 3 years to assess flap viability, scar quality, and recurrence. Most defects were nodular or nodulo-ulcerative BCC, with single-zone involvement most common; multizonal defects accounted for about one-third of cases. Rotation flaps were used in 44%, advancement flaps in 33%, and combined approaches in 22%. The medial cheek was the most frequently reconstructed area. Complications were rare and included flap necrosis (6%), ectropion (6%), transient numbness (17%), and dog-ear formation (22%), all managed successfully. No infections, hematomas, wound dehiscence, or tumor recurrences were observed. Conclusion: Cheek rotation and advancement flaps are safe, effective, and versatile for reconstructing facial defectspost-BCC excision. Individualized planning and meticulous technique are key to optimal outcomes.