An individualized reconstructive algorithm for large facial defects after tumor resection in elderly patients: A retrospective case series.

Reconstruction of large facial defects after tumor resection in elderly patients requires a balance between defect complexity, facial function, and limited physiologic reserve. This retrospective case series included 28 patients aged 65 years or older who were treated between October 2008 and January 2026. A large defect was defined clinically as one unsuitable for primary closure and/or requiring graft or flap reconstruction because of anatomical or functional complexity. Outcomes at the final available follow-up were independently reassessed by two plastic surgeons who had not participated in the index procedures, using de-identified records, postoperative photographs, and a predefined functional checklist. Data were analyzed descriptively. Defect size ranged from 5 × 6 cm to 12 × 16 cm. Full-thickness skin grafts were used in 13 patients, regional or pedicled flaps in 9, and free or bulky myocutaneous flaps in 6. Complete wound closure was achieved in all patients, and all 28 grafts or flaps survived. Five postoperative complications occurred within 30 days: three Clavien-Dindo grade I and two grade II; no grade III-V complications occurred. Median follow-up was 5 months (range, 3-8 months) in the skin-graft group, 10 months (range, 8-24 months) in the regional or pedicled flap group, and 16 months (range, 10-60 months) in the free-flap group. In the 27 definitive/curative-intent cases, no reconstruction failure was documented; the single palliative-intent case achieved stable wound coverage and local symptom control. These findings support an individualized reconstructive strategy based on defect characteristics and operative tolerance.