Reconstruction of midfacial defects following surgical management of skin cancer. The role of tissue expansion.

Compared with other locations on the face, skin cancer of the midface has a higher risk of recurrence owing, in part, to the mode of spread and the high frequency of subclinical extension. Skin cancers occurring in the region of the melolabial crease, nasal columella and medial canthus should be resected by Mohs surgery. Because tumors of the midface are sometimes recalcitrant, there are times when surgical ablation results in extensive defects. Reconstruction may be difficult owing to lack of available donor tissue, or because of previous surgery in the area of the proposed donor region. In these circumstances, tissue expansion in the form of controlled prolonged expansion or rapid intraoperative expansion, may, on occasion, provide the optimal reconstruction of form and function.