Functional and aesthetic outcomes of local flaps vs full-thickness skin grafts in facial reconstruction after skin cancer excision: protocol for a systematic review

Non-melanoma skin cancers (NMSC), specifically basal cell carcinoma and squamous cell carcinoma (SCC) represent the majority of skin malignancies worldwide, with a rapidly increasing global incidence. Whilst surgical excision is the gold standard of treatment there is no clear consensus guiding the choice of reconstructive technique following excision, particularly between local flaps and full-thickness skin grafts (FTSG). This lack of standardized guidance contributes to variability in clinical practice and may influence functional, aesthetic, and patient-reported outcomes. This systematic review aims to compare local flap reconstruction and FTSG following facial NMSC excision, highlighting the clinical indications, functional and aesthetic outcomes, complication rates, and recurrence. The review will follow Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols guidelines and is registered with PROSPERO (CRD420261287537). A comprehensive literature search will be conducted across four databases: (i) Embase, (ii) MEDLINE, (iii) Scopus, and (iv) Cochrane Library. Eligible studies will include adult patients undergoing facial reconstruction after NMSC excision, directly comparing local flaps and FTSG, and reporting relevant outcomes. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment using Cochrane RoB 2.0 and ROBINS-I tools. Where appropriate, meta-analysis will be conducted using random- or fixed-effects models depending on heterogeneity, assessed via I2 statistics. Otherwise, a narrative synthesis will be undertaken. Certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. By synthesizing current evidence, this review aims to clarify differences in outcomes between reconstructive techniques and address the existing evidence-practice gap. Findings may inform clinical decision making, improve consistency in care, and support the development of evidence-based guidelines for facial NMSC reconstruction.