Reviving island pedicle flaps: Tackling superficial necrosis in basal cell carcinoma surgery with recombinant epidermal growth factor

Basal cell carcinoma (BCC) is a malignancy commonly encountered in clinical practice. Here we discuss the management of a superficial flap necrosis of a BCC of size 1.8 cm treated surgically by Wide Excision with a 5 mm margin and covered by an Island Pedicle flap. A 69-year-old diabetic male presented with a growing pigmented ulcerated plaque in the right infraorbital area of 2 months’ duration. On examination clinically, on dermoscopy, and histopathology confirmed the diagnosis of BCC. An excision was done with a 5 mm margin, and reconstruction was done by island pedicle flap. However, on the 2 nd day of surgery, the flap developed a black discoloration, covering nearly 70% of the graft. Friable necrotic tissue was removed, and daily dressing with Recombinant epidermal growth factor continued for 21 days, and the patient achieved complete epithelization. In this case, we will present what went wrong and how we managed to attain a successful outcome.