Reconstruction of Bilateral Paranasal Skin and Soft Tissue Defects Using a Free Bilobed Thoracoacromial Artery Perforator Flap Following Multiple Cutaneous Squamous Cell Carcinomas Resection: A Case Report and Literature Review.

In recent years, the thoracoacromial artery perforator (TAAP) flap has emerged as a promising option for the reconstruction of facial defects, typically utilized in the form of a pedicled flap. However, there remains relatively limited experience in using a free TAAP to repair facial defects. This case describes the first application of a free bilobed TAAP for one-stage reconstruction of multiple facial defects after resecting cutaneous squamous cell carcinomas (cSCC). The patient was a 76-year-old man who noticed progressive enlargement of two black neoplasms around the left and right nose for over 1 year and 3 months, respectively. A preoperative biopsy confirmed both lesions as cSCC. During surgery, two skin and soft tissue defects, measuring approximately 6.5 cm × 3.0 cm and 3.5 cm × 2.0 cm, were left in the bilateral paranasal regions after the removal of tumors. A free bilobed TAAP flap of the appropriate size was designed and harvested to repair these defects. The postoperative course was uneventful, and the patient recovered without complications. Good esthetic and functional outcomes were achieved during a 14-month follow-up period. This report suggests that a free bilobed TAAP flap may be an option for reconstructing multiple facial defects caused by trauma, tumor resection, or other lesions.