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(A) A patient with collapse of the nasal ala and a scar extending through the ala into the left sidewall after closure of a Mohs defect by a dermatologist. (B) Excision of a portion of the sidewall and ala with turn over for internal lining and cartilage graft for support. (C) Forehead flap for closure with placement of suture lines at the aesthetic borders of the sidewall subunit. (D) 6-month postoperative result with improvement of the alar margin but also significant improvement of the appearance of the sidewall with the scars placed at the borders of the subunit to replace the scar in the center portion of the subunit.
Source publication
Defects of the nasal dorsum or sidewall can result from trauma, congenital lesions, extirpation of neoplasms, or iatrogenic injuries. Simple techniques are often used to reconstruct defects in this area with excellent outcomes. Complex defects require more sophisticated techniques including multilayer closures using pedicled flaps or free tissue tr...
Context in source publication
Context 1
... closure. Park also advocates enlarging the defect when more than 50% of a nasal subunit is involved by re- secting the remaining residual subunit to have scars camouflaged within natural creases or at borders of 2 subunits to be more inconspicuous. This concept may also be applied to defects caused by a scar deformity such as the patient shown in Fig. 2. This patient presented with a deformity of the alar rim causing airway obstruc- tion after repair of a Mohs defect by a dermatolo- gist. She also had a scar that extended into the central portion of the nasal sidewall subunit contributing to the deformity. A decision was made to resect the soft tissues of the nasal sidewall and place ...
Citations
The nose and the ear are two of the most common sites for both non-melanoma skin cancer (NMSC) and cutaneous melanoma (CM). The treatment in these two anatomic entities includes early and complete eradication of the cancer, preservation and/or restoration of function, and cosmesis. A systematic defect analysis includes evaluation of immobile surrounding landmarks, vectors of tension, area of recruitment, and preexisting lines and resultant scars. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. The success of the reconstruction is based on selection of the indicated surgical treatment and the execution of the appropriate tissue manipulations. The purpose of this chapter is twofold: (1) to briefly review epidemiology and surgical management of both NMSC and CM and (2) to analyze principles and planning of reconstruction of nose and ear defects.
BACKGROUND: Nasal reconstruction is always a challenge for the plastic surgeon. Loss of
nasal mass is mainly caused by resection of skin cancers. Among the several
available alternatives for covering the skin, skin flaps are the first cosmetic
and functional choice. This study has 2 objectives: (1) to report the experiences
of the Plastic Surgery Service of São Lucas Hospital of the Pontifical Catholic
University of Rio Grande do Sul (Porto Alegre, RS, Brazil) in the
reconstruction of nasal mass losses that resulted from tumor resection and (2)
to describe the most commonly used skin flaps used for defect repair according
to the anatomic subunit.METHODS: This
study analyzed 103 nasal skin flaps used in the reconstruction of 102 nasal
mass losses that resulted from tumor resection in 96 patients who underwent
surgery between December 2008 and December 2011. Mass losses were mapped
according to the anatomic subunits described by Burget and Menick. Moreover,
the number of times each strategy was chosen for the reconstruction of the
different subunits was recorded.RESULTS: Most of the patients were men (51%), and the average age of the analyzed group
was 64.7 years. Basal cell carcinoma was the most prevalent skin cancer
(85.3%), followed by squamous cell carcinoma (5.9%). The bilobed flap was
commonly used for nasal alar lobule reconstruction (44%); V-Y advancement for
the lateral region (72%); extended glabellar for the nasal dorsum (59.2%);
bilobed for the nasal tip (46.2%); and glabellar for the nasal roof as well as
in the cases mentioned above.CONCLUSIONS: Several surgical procedures are used for nasal reconstruction following tumor
resection. The most suitable strategy should be chosen according to the patient
in order to maintain the contours and nasal anatomy, as described by Burget and
Menick.
