The patient had an unidentified dermal filler placed outside of the United States over a decade ago. She developed a subsequent severe reaction which left her with extensive subdermal fibrosis and epidermal necrosis. Pathologic analysis revealed almost entire replacement of the dermal-epidermal layer with a foreign body and granulomatous reaction. The location at the cheek lower lid junction and the available lateral skin laxity deemed the rhomboid flap as the best option for reconstruction.
Editor Recruited By: Michael Golinko, MD
Excision of a necrotic lesion secondary to dermal filler and reconstruction with a local rhomboid flap
If lesion is to be removed an in-office biopsy may help to determine the extent of the surgery.
epidermal, dermal & subcutaneous layer should be identified as one unit when performing facial reconstructive surgery as the deeper layers, below the SMAS, risk damage to branches of the facial nerve. A balance must be maintained keeping the skin flap thick enough that it is receiving maximal blood supply but generally avoiding the depth of fascial or muscular tissue preserve vital structures.
Advantages: The rhomboid flap is an excellent technique that is versatile in that,with pre-operative planning, the flap can come from any side of the lesions (Anterior/posterior/superior/inferior). This allows for the flap to be utilized from the most mobile nearby skin site and for the points of highest tension to be able to be placed away from areas that may cause functional deficits (e.g. lower lid ectropion, oral commissure contracture).
Review Rhomboid Flap Reconstruction of Necrotic Cheek Lesion.