Reconstruction type Factors Region/tumor clearance /comorbidities Recommendation
Local flaps, Skin grafts small areas < 50 cm2 No comorbidities, R0 resection possible. Proceed with the surgery. Consider if nonsurgical methods give equal results.
comorbidities, good tumor clearance. (R0-resection).
Regional flaps Skin grafts for large areas No comorbidities, good tumor clearance. (R0-resection). Proceed with the surgery with adequate precautions.
comorbidities, good tumor clearance(R0-resection). good general condition of the patient.
Free flaps Extensive reconstruction with multiple flap surgery No comorbidities, good tumor clearance(R0-resection). Proceed with the surgery with adequate precautions.
comorbidities, doubtful tumor clearance, poor general condition of the patient. If an alternative procedure can give adequate results, change plan to lesser invasive procedure.
Exploration of free flaps, Flap failure conditions No comorbidities, good tumor clearance(R0-resection)., young individual Proceed with the surgery with adequate precautions.
comorbidities, doubtful tumor clearance, poor general condition of the patient Defer re-surgery, exploration, change plan to more conservative pedicled flaps.