Volume 14, Issue 4 (9-2026)
J Surg Trauma 2026, 14(4): 228-235 |
Back to browse issues page
Ethics code: IR.BUMS.REC.1404.333
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Sajadinejad B S, Mikaeeli M, Hemmati E. The Bilobed Rotation-Advancement Flap for Aesthetic Reconstruction of a Facial Defect After Excision of Giant Basal Cell Carcinoma: A Long-Term Follow-Up Case Report. J Surg Trauma 2026; 14 (4) :228-235
URL: http://jsurgery.bums.ac.ir/article-1-553-en.html
URL: http://jsurgery.bums.ac.ir/article-1-553-en.html
Department of Surgical Technology, School of Allied Medicine, Birjand University of Medical Sciences, Birjand, Iran.
Abstract: (519 Views)
Abstract
Giant basal cell carcinoma (GBCC) of the face is a rare condition that requires both proper oncologic control and acceptable aesthetic outcomes, which is a significant challenge due to the complex reconstructive demands of the post-excision defect.A male patient in his late 60s presented with an ulcerated GBCC measuring 4.5 × 6 cm involving the right cheek. The diagnosis was confirmed preoperatively by punch biopsy, and surgical management was planned to obtain complete excision while addressing the anticipated aesthetic and functional sequelae of a large facial defect. Wide local excision was performed with a 1-cm margin, after which immediate reconstruction was conducted using a regional bilobed rotation-advancement flap. The flap was designed to mobilize adjacent hair-bearing cervical skin to maximize tissue compatibility and restore the natural appearance of the involved facial subunit. Histopathologic examination confirmed pigmented GBCC with clear margins and no perineural or lymphovascular invasion. Postoperatively, facial nerve function was maintained, healing was uneventful, and long-term follow-up indicated stable reconstruction without any evidence of recurrence.This case highlights the bilobed rotation-advancement flap as an advantageous technique for reconstruction of selected sizable defects after excision of GBCC. The favorable long-term outcome indicates that, when properly planned, this technique can accomplish functional preservation, oncologic safety, and aesthetically acceptable restoration without the need for more extensive reconstructive procedures.
Giant basal cell carcinoma (GBCC) of the face is a rare condition that requires both proper oncologic control and acceptable aesthetic outcomes, which is a significant challenge due to the complex reconstructive demands of the post-excision defect.A male patient in his late 60s presented with an ulcerated GBCC measuring 4.5 × 6 cm involving the right cheek. The diagnosis was confirmed preoperatively by punch biopsy, and surgical management was planned to obtain complete excision while addressing the anticipated aesthetic and functional sequelae of a large facial defect. Wide local excision was performed with a 1-cm margin, after which immediate reconstruction was conducted using a regional bilobed rotation-advancement flap. The flap was designed to mobilize adjacent hair-bearing cervical skin to maximize tissue compatibility and restore the natural appearance of the involved facial subunit. Histopathologic examination confirmed pigmented GBCC with clear margins and no perineural or lymphovascular invasion. Postoperatively, facial nerve function was maintained, healing was uneventful, and long-term follow-up indicated stable reconstruction without any evidence of recurrence.This case highlights the bilobed rotation-advancement flap as an advantageous technique for reconstruction of selected sizable defects after excision of GBCC. The favorable long-term outcome indicates that, when properly planned, this technique can accomplish functional preservation, oncologic safety, and aesthetically acceptable restoration without the need for more extensive reconstructive procedures.
Type of Study: Case Report |
Subject:
Otolaryngology_ENT
Received: 2026/04/25 | Accepted: 2026/07/1 | ePublished ahead of print: 2026/07/21 | Published: 2026/09/1
Received: 2026/04/25 | Accepted: 2026/07/1 | ePublished ahead of print: 2026/07/21 | Published: 2026/09/1
References
1. Kurian KE, Yong JS, Oyer SL, Park SS. Patients with giant facial basal cell carcinoma, who are they?-a psychosocial profile. Laryngoscope. 2025;135(7):2335-241. [DOI: 10.1002/lary.32049] [PMID: 39932152] [DOI:10.1002/lary.32049] [PMID] [PMCID]
2. Di Lorenzo S, Zabbia G, Corradino B, Tripoli M, Pirrello R, Cordova A. A rare case of giant basal cell carcinoma of the abdominal wall: excision and immediate reconstruction with a pedicled deep inferior epigastric artery perforator (diep) flap. Am J Case Rep. 2017;18:1284-8. [DOI: 10.12659/ajcr.905671] [PMID: 29199268] [DOI:10.12659/AJCR.905671] [PMID] [PMCID]
3. Zoccali G, Pajand R, Papa P, Orsini G, Lomartire N, Giuliani M. Giant basal cell carcinoma of the skin: literature review and personal experience. J Eur Acad Dermatol Venereol. 2012;26(8):942-52. [DOI: 10.1111/j.1468-3083.2011.04427.x] [PMID: 22211959] [DOI:10.1111/j.1468-3083.2011.04427.x] [PMID]
4. Tuerdi M, Yarbag A, Maimaiti A, Mijiti A, Moming A. Standard surgical excision and reconstruction of giant basal cell carcinoma of the face: may be an alternative to the Mohs micrographic surgery. J Eur Acad Dermatol Venereol. 2014;28(11):1572-3. [DOI: 10.1111/jdv.12360] [PMID: 24397256] [DOI:10.1111/jdv.12360] [PMID]
5. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual. 2017. [DOI: 10.3322/caac.21388] [DOI:10.3322/caac.21388] [PMID]
6. Maimaiti A, Mijiti A, Yarbag A, Moming A. Giant basal cell carcinoma of the face: surgical management and challenges for reconstruction. J Laryngol Otol. 2016;130(2):176-82. [DOI: 10.1017/S0022215115003333] [PMID: 26676100] [DOI:10.1017/S0022215115003333] [PMID]
7. Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update. Eur J Cancer. 2023;192:113254. [DOI: 10.1016/j.ejca.2023.113254] [PMID: 37604067] [DOI:10.1016/j.ejca.2023.113254] [PMID]
8. Oudit D, Pham H, Grecu T, Hodgson C, Grant ME, Rashed AA. Reappraisal of giant basal cell carcinoma: Clinical features and outcomes. J Plast Reconstr Aesthet Surg. 2020;73(1):53-7. [DOI: 10.1016/j.bjps.2019.06.029] [PMID: 31519500] [DOI:10.1016/j.bjps.2019.06.029] [PMID]
9. Dobratz EJ, Hilger PA. Cheek defects. Facial Plast Surg Clin North Am. 2009;17(3):455-67. [DOI: 10.1016/j.fsc.2009.05.004] [PMID: 19698923] [DOI:10.1016/j.fsc.2009.05.004] [PMID]
10. Djawad K, Wahab S, Nurdin A. Successful basal cell carcinoma defect reconstruction using combination of rotation and advancement flap: Two case reports. Dermatol Reports. 2021;13(2):9087. [DOI: 10.4081/dr.2021.9087] [PMID: 34497698] [DOI:10.4081/dr.2021.9087] [PMID] [PMCID]
11. Chung KC. Grabb and Smith's Plastic Surgery. 2024. Wolters Kluwer. [URL: https://www.wolterskluwer.com/en/solutions/ovid/grabb-and-smiths-plastic-surgery-3467]
12. Maimaiti A, Mijiti A, Yarbag A, Moming A. Giant basal cell carcinoma of the face: surgical management and challenges for reconstruction. J Laryngol Otol. 2016;130(2):176-82. [DOI: 10.1017/S0022215115003333] [PMID: 26676100] [DOI:10.1017/S0022215115003333] [PMID]
13. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition ajcc cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-9. [DOI: 10.3322/caac.21388] [PMID: 28094848] [DOI:10.3322/caac.21388] [PMID]
14. Mott SE, Hunter WJ, Silva E, Huerter CJ, et al. Approach to management of giant basal cell carcinomas. Cutis. 2017;99(5):356-62. [PMID: 28632797]
15. Kang AS, Kang G, Kathuria HS. Super giant basal cell carcinoma: a comprehensive systematic review. Ann Med Surg (Lond). 2024;86(5):2935-9. [DOI: 10.1097/MS9.0000000000001958] [PMID: 38694394] [DOI:10.1097/MS9.0000000000001958] [PMID] [PMCID]
16. Board, WHOCoTE. Skin tumours: who classification of tumours. 2025. World Health Organization. [URL: https://publications.iarc.who.int/Book-And-Report-Series/Who-Classification-Of-Tumours/Skin-Tumours-2025]
17. Requena C, Serra-Guillén C, Sanmartín O. Histologically agressive basal cell carcinoma with particular emphasis on galeal infiltration of the scalp. Actas Dermosifiliogr. 2022;113(6):575-82. [DOI: 10.1016/j.ad.2022.01.026] [PMID: 35339267] [DOI:10.1016/j.ad.2022.01.026] [PMID]
18. Purnell JC, Gardner JM, Brown JA, Shalin SC. Conventional versus giant basal cell carcinoma, a review of 57 cases: histologic differences contributing to excessive growth. Indian J Dermatol. 2018;63(2):147-54. [DOI: 10.4103/ijd.IJD_165_17] [PMID: 29692457] [DOI:10.4103/ijd.IJD_165_17] [PMID] [PMCID]
19. Welsch M.J, Troiani BM, Hale L, DelTondo J, Helm KF, Clarke LE. Basal cell carcinoma characteristics as predictors of depth of invasion. J Am Acad Dermatol. 2012;67(1):47-53. [DOI: 10.1016/j.jaad.2011.02.035] [PMID: 22507669] [DOI:10.1016/j.jaad.2011.02.035] [PMID]
20. He G, Yang Q, Shen Y, Zhang L, Wu J, Cheng H. Application of modified kite flap in reconstruction of facial wounds after operation and case series. Clin Cosmet Investig Dermatol. 2024;17:725-30. [DOI: 10.2147/CCID.S456997] [PMID: 38545570] [DOI:10.2147/CCID.S456997] [PMID] [PMCID]
21. Ebrahimi AM, Ashayeri M, Rasouli HR. Comparison of local flaps and skin grafts to repair cheek skin defects. J Cutan Aesthet Surg. 2015;8(2):92-6. [DOI: 10.4103/0974-2077.158444] [PMID: 26157308] [DOI:10.4103/0974-2077.158444] [PMID] [PMCID]
22. Patel KG, Sykes JM. Concepts in local flap design and classification. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2011;22(1):13-23. [DOI: 10.1016/j.otot.2010.09.002] [DOI:10.1016/j.otot.2010.09.002]
23. Baker SR. Local Flaps in Facial Reconstruction E-Book.Elsevier Health Sciences.2021. [URL: https://shop.elsevier.com/books/local-flaps-in-facial-reconstruction/baker/978-0-323-68390-6]
24. Furr MC, Wang TD. Complex local flap design in cheek reconstruction. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2011;22(1):53-8. [DOI: 10.1016/j.otot.2010.08.005] [DOI:10.1016/j.otot.2010.08.005]
25. Shim HS, Ryoo HJ, Choi JS, Park JA, Kim YH. Principles and clinical application of free-style capillary perforator-based flap for coverage of facial skin cancer defects. Cancers (Basel). 2024;16(12):2206. [DOI: 10.3390/cancers16122206] [PMID: 38927912] [DOI:10.3390/cancers16122206] [PMID] [PMCID]
26. Mohapatra DP, Friji MT, Dinesh Kumar S, Chittoria RK, Pathan I, Koliath S.Reconstruction of defects following excision of basal cell carcinoma of face: a subunit-based algorithm. J Cutan Aesthet Surg. 2023;16(1): 1-13. [DOI: 10.4103/JCAS.JCAS_87_21] [PMID: 37383975] [DOI:10.4103/JCAS.JCAS_87_21] [PMID] [PMCID]
27. Mishra B, Mallik S, Agnihotry I, Behera J. Aesthetic reconstruction based on facial subunit principle for basal cell carcinoma of the face: a retrospective analysis. Cureus. 2024;16(3):56826. [DOI: 10.7759/cureus.56826] [PMID: 38654794] [DOI:10.7759/cureus.56826]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Attribution-NoneCommercial CC BY-NC
