Background: Large cutaneous defects of the face have traditionally been reconstructed with cervicofacial rotation flaps. Objective: To measure advancing distance and assess vascular reliability of superficial musculoaponeurotic system (SMAS) island flaps for reconstruction of large cutaneous facial defects. Methods: The study design was a retrospective case series of all patients who had undergone reconstruction of facial defects 3 cm or greater with fasciocutaneous SMAS island flaps from 2009 to 2023. Flap advancing distance and vascular compromise were analyzed. Results: The average patient age at the time of surgery was 69 (standard deviation [SD] 15) years with more males (n = 33, 92%) than females (n = 3, 8%). Of 36 patients, 18 had posterior defects, 16 had anterior defects, and 2 had defects straddling both regions. Fifteen cases had a full fasciocutaneous SMAS island flap, and 21 underwent the partial island modification. Flap ischemia occurred in three cases (8%). The mean flap advancing distance was 3.8 cm (SD 1.1). Of the 5 smokers, none had ischemia of the flap. The median follow-up time was 2 years (range 12-3,170 days). Conclusions: Fasciocutaneous SMAS island and partial island flaps are reliable options for the reconstruction of large cheek defects (3 cm or greater). Anterior pedicle blood supply is more reliable for defects anterior to the line from the lateral brow to the angle of the mandible, whereas the posterior pedicle is a better choice for defects posterior to that line.
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