Abstract

Background: The temporal region accounts for roughly 9–13% of all head and neck basal cell carcinomas (BCCs). Large surgical defects in the temporal region following cutaneous oncologic resections present major biomechanical challenges. Traditional techniques including extensive local flaps or full-thickness skin grafts (FTSG) frequently result in temporal hollowing, texturing mismatches, distortion of critical free margins, neurovascular damages or permanent scarring alopecia along the hairline. Case Presentation: We present the case of a 66-year-old female patient who presented with a substantial, Pigmented basal cell carcinoma (BCC) of the right temporal region. Wide local excision with clear histopathological deep and peripheral margins yielded a substantial 3.5X2.5cm surgical defect. Surgical Technique (The Margin-Anchor Flap): Rather than using a skin graft, a modified local Rotational-Advancement flap was designed. The superior border of the flap incision was extended superiorly by >0.5cm along the temporal aesthetic line to recruit local tissue horizontally. The primary body of the flap was advanced under optimal physiological tension and anchored firmly to the underlying deep temporal fascia using slowly absorbable 4-0 vicryl sutures. This “Margin-Anchor” technique locked the structural closing vectors into place, absorbing all kinetic stress and shielding the periorbital units (eyebrow, lateral canthus), the cheek, the angle of the mouth, and the pinna from anatomical distortion. A small, residual peripheral crescent of the defect adjacent to the permanent frontotemporal hairline was left to heal via controlled secondary intention. Results: Complete wound healing and edge epithelialization were achieved within 3 weeks without any flap ischemia or necrosis. There was zero postoperative ectropion, eyebrow lag, pinna displacement, or facial asymmetry. The micro-deficit adjacent to the scalp healed seamlessly, beautifully preserving the natural hairline contour and completely avoiding surgical scarring alopecia or temporal hollow flattening. Conclusion: The Margin-Anchor Flap utilizing a split-closure approach offers a powerful, low-morbidity option for large temporal reconstructions, eliminating the need for extensive autologous grafting or high-risk tissue rearrangement.