**4. Cheek reconstruction**

The cheek provides abundant subcutaneous tissue, which is mobile and has a perfect color match. Because of the laxity of the cheek, adjacent undermining and primary closure can be used to reconstruct many defects. Flaps can be designed within this tissue with minimal distortion to surrounding facial features and minimal dead space (Figure 12).

**Figure 12.** The cheek unit with subdivision of c and d, used by permission of author Davide Brunelli M.D, www.med-ars.it

In females the face has almost no hair so the reconstruction can begin at a younger age and more donor sites are available than the male patients. In the female neck skin can be expanded and be used to cover the chin and even cheek defects (Figure 13 - 15).

**Figure 13.** Bilateral cheek scars, expanded neck skin via tissue expander

**Figure 14.** Frontal view of the scar after 5 years

including the sideburn and adjacent cheek or beard region can be reconstructed with a combination of any of these three primary options: the scalp transposition flap, the cervicofa‐

The cheek provides abundant subcutaneous tissue, which is mobile and has a perfect color match. Because of the laxity of the cheek, adjacent undermining and primary closure can be used to reconstruct many defects. Flaps can be designed within this tissue with minimal

**Figure 12.** The cheek unit with subdivision of c and d, used by permission of author Davide Brunelli M.D, www.med-ars.it

In females the face has almost no hair so the reconstruction can begin at a younger age and more donor sites are available than the male patients. In the female neck skin can be expanded

and be used to cover the chin and even cheek defects (Figure 13 - 15).

distortion to surrounding facial features and minimal dead space (Figure 12).

**Figure 11.** The side burn area, used by permission of author Davide Brunelli M.D, www.med-ars.it

cial advancement flap, or the pedicled submental flap.

594 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**4. Cheek reconstruction**

**Figure 15.** Result 8 years postoperatively

In the male child or adolescent, a facial skin defect reconstruction is completely different from females because transferring a hair bearing flap in a child is unsightly and the definite reconstruction of the facial hair bearing areas must be postponed until the patient has grown hair (Figures 16 and 17).

**Figure 16.** A 14-year-old male patient with a unit 4 scar

**Figure 17.** Lateral view of the same patient

## **5. Neck reconstruction**

Zone 9 is the neck area contiguous with the chin and if the facial hair is present there is no need to reconstruct this area with hair bearing flaps, in these instances the patient can cover the neck scar with a beard.
