A patient with a complex facial defect can often be managed by a dermatologic surgeon. However, some patients should be referred to a specialist if certain risk factors are present. The authors are from Stanford University.


Patient selection: complex facial defect secondary to trauma, cancer surgery or other cause


Reasons to transfer a patient to a specialist:

(1) presence of a nasal defect involving the sinuses

(2) presence of an upper nasal defect that requires placement of calvarial bone

(3) presence of a full thickness eyelid lesion involving > 50% of the lid

(4) extensive deep facial defects that involve multiple cosmetic subunits and that will require specialized coverage

(5) presence of a full thickness lip defect which requires a repair that could reduce the size of the mouth opening

(6) presence of a full thickness lip defect that involves the oral cavity

(7) presence of a near total or total auricular defect

(8) a patient with significant comorbidities and poor general health


The specialist will usually be able to perform the repair faster, with less morbidity and with improved cosmesis.


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