Camacho-Martínez, Francisco MiguelRollón, AngelSalazar, ClaraRodríguez-Rey, Elena MMoreno, David2014-04-072014-04-072011-11Camacho-Martínez FM, Rollón A, Salazar C, Rodríguez-Rey EM, Moreno D. Free flaps in surgical dermatology. Comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions. An Bras Dermatol 2011; 86(6):1145-500365-0596http://hdl.handle.net/10668/1573Case Reports; Journal Article;BACKGROUND Dermatologic surgeons routinely harvest pedicled flaps at distance with an axial or random pattern to repair facial defects. These types of skin flaps are time-consuming and have high economic, social and personal costs. These drawbacks could be avoided with the introduction of a single-step transfer of free flaps to the recipient site, with microvascular anastomosis. OBJECTIVE To demonstrate that better results are obtained with myocutaneous or fasciocutaneous free flaps and which one is more suitable in surgical dermatology. MATERIAL AND METHODS We selected two patients of opposite sexes and similar ages who had undergone Mohs surgery to remove recurrent malignant tumors that were located in the upper cheek bordering the zygomatic zone. The woman was treated with a fasciocutaneous radial free flap and the man with a rectus abdominis free flap. RESULTS Both patients had excellent immediate postoperative outcomes. Complications observed in the male patient were related to a previous pulmonary alteration. The fasciocutaneous radial free flap reconstruction was easier to perform than the rectus abdominis free flap; nevertheless, the radial free flap is very thin and, although the palmaris longus tendon is used, it does not yield enough volume, requiring later use of implants. In contrast, the rectus abdominis free flap transfers a wide flap with enough fat tissue to expand in the future. As for the cosmetic results regarding the donor site, the rectus abdominis free flap produces better-looking scars, since secondary defects of the palmar surface cannot be directly closed and usually require grafting - a situation that some patients do not accept. CONCLUSIONS In surgical dermatology, each case, once the tumor has been extirpated, requires its own reconstructive technique. The radial free flap is suitable for thin patients who are willing to cover their arm with a shirt. The rectus abdominis free flap is best suited for obese patients with deep and voluminous defects, although it is necessary to dislocate the navel from its original position.enMohs surgeryMuscle developmentSurgical flapsColgajo MiocutáneoProcedimientos quirúrgicos reparadoresRecto del abdomenTrasplante de pielMedical Subject Headings::Anatomy::Musculoskeletal System::FasciaMedical Subject Headings::Check Tags::FemaleMedical Subject Headings::Anatomy::Body Regions::Extremities::Upper Extremity::ForearmMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Check Tags::MaleMedical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle AgedMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Microsurgery::Mohs SurgeryMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Reconstructive Surgical ProceduresMedical Subject Headings::Anatomy::Musculoskeletal System::Muscles::Muscle, Skeletal::Abdominal Muscles::Rectus AbdominisMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Transplantation::Tissue Transplantation::Skin TransplantationMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Surgically-Created Structures::Surgical FlapsMedical Subject Headings::Anatomy::Stomatognathic System::Cheekresearch article22281903open access1806-4841