Tunneled flaps reconstruction after facial tumor resection: Retrospective study and new forehead flap.

Background: Surgical defects of the face resulting from the removal of skin tumors can present significant challenges, particularly when reconstructive methods aim to maintain the integrity of the facial anatomical units. The face is divided into specific aesthetic units, each characterized by skin with uniform features such as thickness, subcutaneous tissue, and adhesion to underlying structures. Material and methods: From 2014 to 2024, 24 patients were treated with tunneled flaps for facial defects due skin tumors at the Maxillofacial Surgery department, University Hospital of Ancona, Italy. Results: In a study of 24 patients (15 males, 9 females; mean age 73), only 5 had a history of malignant facial skin tumors, with 3 presenting due to local recurrence. Lesions ranged in size from 19 × 15 mm to 30 × 24 mm. 10 patients had disease at the eyelid level and 14 at the nose level. The most common diagnosis was basal cell carcinoma (15 cases), followed by squamous cell carcinoma (7 cases) and Merkel cell carcinoma (2 cases). No lymph node or distant metastases were detected preoperatively. All patients had good or very good cosmetic outcomes, with no complications or recurrences observed during follow-up. No complication was observed. Conclusion: The tunneled pedicled flap is an excellent choice for reconstructing upper eyelid and nasal defects. This technique is easy to manage, can be completed in a single stage with satisfactory outcomes, and effectively hides donor site scars along natural facial lines. Moreover, it maintains facial symmetry and can be performed under local anesthesia, with or without sedation.