The team approach to management of massive facial skin cancers is now possible. The introduction of more sophisticated and refined methods to definitively repair and reconstruct large facial defects has allowed oncologic surgeons to proceed with a curative resection. The patients in our series could not have undergone massive cranio-facial resections if definitive and immediate reconstructive options were not available. Surgical management of patients with advanced facial skin cancers presents a challenging problem and involves a multidisciplinary team that includes an otolaryngologist, a neurosurgeon, an oculoplastic surgeon, and a plastic and reconstructive surgeon. The massive size of the defects and exposure of vital structures demands their immediate reconstruction with well-vascularized tissues. Free flap transfer in those cases is a first choice of the treatment. Depending on the depth and geometry of the defect, muscle or myocutaneous free flaps are preferable choices as most versatile and reliable flaps. This complex approach for management of patients with extensive facial skin cancers may extend their survival rate and quality of life. Free flaps are a reasonable and reliable option.
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