Modified O to T Advancement Flap for Temporal Reconstruction after Basal Cell Carcinoma Excision
DOI:
https://doi.org/10.51278/bse.v6i3.2399Keywords:
Basal Cell Carcinoma, Temporal Reconstruction, Advancement Flap, O-To-T Plasty, Case ReportAbstract
Temporal defects after basal cell carcinoma (BCC) excision require reconstruction that balances tissue recruitment, adjacent facial landmarks, and oncological documentation. This report describes a modified O-to-T advancement flap in a 77-year-old woman with a left temporal pigmented lesion that had enlarged slowly over approximately 20 years. The patient reported itching, recurrent surface injury, bleeding, and crusting, with prolonged occupational sunlight exposure. Examination showed a well-demarcated hyperpigmented lesion measuring 2.5 × 3 cm. Dermoscopy demonstrated large blue-grey ovoid nests and multiple blue-grey globules with keratinous material, ulceration, and crusting. Histopathology confirmed nodular BCC. Under general anaesthesia, an ellipse measuring 2.5 × 4 cm and the flap incisions were marked. Following excision and undermining, adjacent tissue was advanced toward a central junction and closed using interrupted 5-0 polypropylene sutures. At the documented day-14 review, the scar remained erythematous with small crusts, but no wound dehiscence, distal flap necrosis, or active infection was described. These findings support early flap viability and wound continuity. They do not establish mature cosmetic quality or durable oncological control. The complete pathology report, surgical margin status, and rationale for the recorded stage were unavailable, and one-month outcomes mentioned in the original abstract were not described in detail. The case illustrates technical feasibility in an anatomically sensitive region while emphasizing the need to verify clearance, reconcile pathological staging, and obtain longer functional, cosmetic, and oncological follow-up.
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