Cheek and eyelid reconstruction: The resurrection of the angle rotation flap

Background: Reconstruction of larger cheek and eyelid defects may pose a dilemma for surgeons, since flaps used in reconstruction maybe difficult to design, be unreliable, require extensive dissection, and result in neck scarring. Consequently, the authors wish to simplify and expand an overlooked flap, the angle rotation flap, which moves tissue in both a medial and upward direction. Methods: Twenty patients with cheek and eye-lid defects were treated by the angle rotation flap. In this flap design, the angle designed below the ear was closed primarily and the neck tissue previously there was rotated upward and forward to lie in front of the ear. The portion of the flap that was in front of the ear was transposed to the lower lid/cheek area. This flap was modified in several patients by elevation in the deep plane and first-stage tissue expansion. Results: In all cases, good coverage was provided for medial cheek and lower eyelid defects with minimal scarring on the neck. There were no flap losses of any kind. There were no major complications, and all minor incidences were treated by minimal procedures without long-term sequelae. Conclusion: The modified angle rotation flap is a useful tool for cheek and eyelid defects.