Reconstruction with O-Z Flap and Double O-Z Flap after Mohs' Micrographic Surgery for Skin Cancer of the Face

Kim, Hoon Soo; Jung, Do Sang; Seo, Sang Hee; Ko, Hyun Chang; Kim, Moon Bum; Oh, Chang Keun; Kwon, Kyung Sool

Abstract

BACKGROUND: The O-Z flap is a kind of rotational flap that consists of a combination of two opposing rotation flaps. The double O-Z flap is a variant of the O-Z flap applied in multiple adjacent surgical defects that can simplify closure by combining closure into one technique.
OBJECTIVE
To report our experience with the O-Z flap and double O-Z flap in the reconstruction of surgical defects of the face after Mohs' micrographic surgery (MMS), using postoperative clinical and cosmetic results.
METHODS
Sixteen patients diagnosed with non-malignant melanoma skin cancer on the face were treated with MMS. The resultant surgical defects were reconstructed with an O-Z flap in 14 patients and with a double O-Z flap in 2 patients. Clinical outcomes were reviewed, and cosmetic results were scored as excellent, good, fair, poor, or very poor.
RESULTS
In the 14 patients using O-Z flap, 6 cases were located on the temple, 4 on the forehead, 2 on the cheek, and 1 of each on the nose and philtrum. Of the two patients using double O-Z flap, one had two adjacent basal cell carcinomas on the cheek, and the other had two adjacent squamous cell carcinomas on the forehead. The size of the primary defects ranged from 1.1 to 2.5 cm in greatest diameter (mean, 1.93 cm). There were no significant local complications. There was no tumor recurrence, and 14 of 16 patients showed satisfactory aesthetic outcomes scored as excellent or good.
CONCLUSION
O-Z flap reconstruction was effective for the closure of surgical defects with limited skin laxity in the face. The double O-Z flap is ideally suited to combine closure of adjacent surgical defects into one technique without exerting undue tension or distorting the surrounding structures. We found these flaps were simple to construct and provided aesthetically pleasing results. Therefore, they could be useful reconstructive options in facial skin defects after MMS.