Revisiting closure options for heavily irradiated tissue following Mohs excision: A case report and review of literature

INTRODUCTION: Squamous cell carcinoma is a cancer of the squamous cells of the epithelium, often treated with radiation therapy or surgical resection. Patients who undergo Mohs excision on the face are left with defects that require thoughtful reconstruction, especially if previously treated with radiotherapy. CASE PRESENTATION: We report a patient who suffered from squamous cell carcinoma of the skin overlying his right cheek. After receiving upwards of 10,000 cGY of radiotherapy, he underwent Mohs excision. Despite conventional therapy protocols, which would normally consist of a free-tissue transfer, a successful rhomboid flap was performed to cover the defect. DISCUSSION: Conventional reconstruction of a previously irradiated area would consist of using non-irradiated tissue. Data on whether such a large, heavily irradiated defect of the face could be repaired using a local flap is practically non-existent. CONCLUSION: This case demonstrates that a local flap can still be successful even with large facial defects and previously radiation therapy, sparing the patient from free-tissue transfer and its possible complications, while leaving the option of a free-tissue transfer available in case of flap failure. This case serves as a reminder that local flaps are still viable options for such defects.