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Basal cell carcinoma of the nasal dorsum: (A) Design of the island forehead flap based on supratrochlear artery, (B) Two weeks post-operation and (C) One month post-operation: reducing of glabellar swelling.
Source publication
Reconstruction of nasal skin after tumor resection is imperative for full patient rehabilitation; and use of similar skin is necessary to achieve best esthetic and functional results.
This clinical series study represent management of patients with large nasal defects (up to 4x7 cm) using subcutaneous pedicle island paramedian forehead flap, during...
Context in source publication
Context 1
... site defect was re- paired primarily with releasing of forehead muscle. Distal end of the island flap could be extended to the hairline and direction of the island vertically or oblique was dependent on the direction of supratrochlear artery (by means of Doppler probe), and usually it was verti- cal ( Figure 2). If a patient had a transverse incision in the forehead in the region of flap design, we were not able to use this kind of flap, and other options must be considered for nasal reconstruction. ...Similar publications
The paramedian forehead flap is a good option for reconstruction of large and complex nasal defects. For full-thickness defects, it may be used alone or in combination with other methods. It can be easily performed under local or general anesthesia, providing a very good color and texture matching to the nasal skin. The only disadvantage is that it...
Repair of a failed primary lower eyelid reconstruction is a difficult prospect and requires special thought after the best available reconstructive option has already been utilized. Reconstruction must be tailored specifically to the defect and the local reconstructive options. Here, we describe the case of an 88-year-old male with a successful sal...
Citations
... Ebrahimi A et al. [29] reported no major complications in their study. ...
A 65 year male presented with squamous cell carcinoma of left side of nose.
... In patients who smoke, in diabetics and patients with transverse forehead scars, this type of paramedian forehead flap is unsuitable and is at risk of necrosis. 16 When locoregional flaps are not feasible a free flap may be required for soft tissue coverage. In selected patients, microvascular free flaps have shown good results in terms of safety and reliability in nasal reconstruction. ...
In nasal reconstruction, it is necessary to replace all anatomic layers in order to reinstate correct aesthetics. The most apt donor site to use in order to cover the nose has been recognized as forehead skin. Traditionally 2 phases are required to reconstruct the forehead flap; however, an intermediate third phase was described by Millard which is between transfer of the flap and division of the pedicle. These methods will be compared in this study with regard to both complication rates and aesthetic results in high vascular risk patients.
46 patients were enrolled in the study, all of whom were undergoing either total or subtotal nasal reconstruction from January 2001 to March 2018. The 2-step technique (2S Group) was performed on 30 patients and the 3-step technique (3S Group) was performed on 16. Evaluation questionnaires were completed by patients and a plastic surgeon who was extraneous to the study to evaluate aesthetic satisfaction. Complications other than flap necrosis such as infection, wound dehiscence and hematoma were recorded. VAS and Likert mean values, used to evaluate aesthetic satisfaction, were examined with a Student t test and were discovered to be relevant. Complication rates studied with Fisher exact test showed no statistically significant difference between the 2 groups. The 3-phase method for nose reconstruction using a forehead flap represents a better functional and aesthetic option for patients at high vascular risk.
... Ebrahimi et al. [11] managed to reconstruct the nose in a single stage using forehead flap by islanding it and passing it under a skin tunnel at the medial side of the eyebrow. In this way, they avoided division of the flap in a second stage, but using this technique, the flap could only reach till above the tip of the nose. ...
... - , (. 1d). , , , , - - [2]. , ( ) -, - [9]. - , [9,10]. ...
... In addition, alar defect was also reconstructed owing to little skin-island on top of the myofascial flap. The present design of the flap previously presented by Ebrahimi et al. [11]. In that similar study, the authors included periosteum in pedicle for better vascularity. ...
... Despite the aesthetic outcome, these areas have a functional importance for a successful recovery of the patient. The reconstruction plan using local and regional flaps is chosen considering the location of the defect, the size and the age of the patient (12). ...
Introduction. The paramedian forehead flap is one of the best options for reconstruction of the median upper two-thirds of the face due to its vascularity, color, texture match and ability to resurface all or part of the reconstructed area. The forehead flap is the gold standard for nasal soft tissue reconstruction and the flap of choice for larger cutaneous nasal defects having a robust pedicle and large amount of tissue. Materials and Methods. We are reporting a clinical series of cutaneous tumors involving the nose, medial canthus, upper and lower eyelid through a retrospective review of 6 patients who underwent surgical excision of the lesion and primary reconstruction using a paramedian forehead flap. Results. The forehead flap was used for total nose reconstruction, eyelids and medial canthal reconstruction. All flaps survived completely and no tumor recurrence was seen in any of the patients. Cosmetic and functional results were favorable. Conclusions. The forehead flap continues to be one of the best options for nose reconstruction and for closure of surgical defects of the nose larger than 2 cm. Even though is not a gold standard, median forehead flap can be an advantageous technique in periorbital defects reconstruction.
... We reported single stage modification of this flap previously. [16] The most significant advantage of this flap was the ability to bury the pedicle, obviate the second stage, preservation of interbrows distance, and limited scar length in the forehead donor site. In both forms, preservation of vascular pedicle is necessary. ...
Objective
A variety of nasal skin reconstruction methods are available to meet the esthetic patient's needs. In this article, we review some of modifications of these procedures and share our experience in reconstruction of different parts of the nasal skin following skin tumor ablation.
Patients and Methods
From January 2010 to January 2014, 171 patients underwent nasal skin reconstruction after excising cancerous lesions of the involved nasal skin. The patient's history, pre- and post-operation photographs, and the surgery data were collected and assessed. Demographic data related to the type of cancer, defect size and location, type of reconstruction were collected.
Results
A variety of local flaps were used based on location and defect features. Nearly all flaps healed primarily without postsurgical significant complications.
Conclusion
According to the results and the outcomes of the operations, we concluded that a certain flaps are more effective than others in nasal skin reconstruction. Local flap reconstruction of the nose has good esthetic result with low complication rate.
... Donor site closure is performed with minimal tension. Residual defects can heal by second intention or a Wplasty is performed 9 . It is used to repair mediodistal nasal defects to reconstruct entire external nasal framework even when there is lost cartilage support. ...
INTRODUCTION
:
Face
represents complete personality of human being.
Cosmetically it is very important part of a person especially for woman. There are many situations
when due to disease or trauma, facial defect arises, which requires reconstruction by either local
or distant
surgical flaps
.
METHODS
AND MATERIALS
:
In rural places, we come across many
patients suffering from trauma and skin malignancy of face. These patients require reconstruction
done esthetically with local flaps. Objective of this study is to share our exper
ience of providing
esthetically good results at our secondary referral care center.
Hereby, we present case series of
14 patients operated at our institute. These patients were analyzed according to the age, sex,
nature of injury and anatomical location of
lesion on the face. All these patients were operated
and reconstruction of defect was done with various local flaps best suited for respective lesion,
under local anesthesia or sedation. Post
-
operative nature of wound was analyzed for flap viability
or fl
ap necrosis
.
RESULTS
:
Amongst them were 7 male and 7 female, ages ranging from 4 to 80
years. 7out of 14 patients were of basal cell carcinoma, 4 were due to trauma, 2 were due to dog
bite and 1 case of recurrent pleomorphic adenoma at root of nose. All
patients had excellent flap
viability at end of 6 months and flap achieving almost similar color and contour as that of
surrounding skin.
CONCLUSION
:
Reconstruction of facial defects by local flaps is very easy and
cost effective technique. This can be don
e even at secondary referral care centre with minimal
availability of facilities
... About 3 weeks later the pedicle is thinned and after 6 weeks the PFF is detached from its base and sutured. [33,34] For small-to medium-sized defects of nasal ala, infratip or columella the cheek-to-nose interpolation flap should be used. The vascular supply is based on tributaries of the angular artery. ...
Basal cell carcinoma of the nose is common, with a potential of local recurrence and high-risk features.
We provide a review on anatomy of the nose, tumour surgery and defect closure on the nose. We analysed our own patients with nasal BCC of a 24 months period.
We identified 321 patients with nasal BCC. There was a predominance of female patients of 1.2 to 1. The mean age was 74.8 years. Slow Mohs technique was employed for all tumours until 3D tumour-free margins were achieved. That resulted on average in 1.8 ± 0.7 Mohs stages. The most common histologic types were solitary (n = 182), morpheic (79), and micronodular (20), Perineural infiltration was evident in 56 tumours. Primary closure after mobilisation of soft tissue was possible in 105 BCCs. Advancement flaps were used in 91 tumours, rotation flaps in 47, transposition flaps in 34 tumours, and combined procedures in 6 cases. In 36 patients full-thickness skin grafting was performed. In two patients healing by second intention was preferred. Partial flap loss was seen in four patients (1.4%). All of them had significant underlying pathologies. None of the tumours treated showed a relapse during the observation time. However, this is a limitation of the present study since follow-up was on average only 10 months.
BCCs of the nose are common. Only 3D-controlled micrographic surgery (Mohs or slow Mohs) guarantee a high rate of complete tumour removal and a very low risk of recurrence.
... Donor site closure is performed with minimal tension. Residual defects can heal by second intention or a Wplasty is performed 9 . It is used to repair mediodistal nasal defects to reconstruct entire external nasal framework even when there is lost cartilage support. ...
Aim of this study was to evaluate the split skin graft held in place with a polyethylene stent for the treatment of oral submucous fibrosis.
Fifteen prospective patients diagnosed clinically with oral submucous fibrosis, from June 2011 to 12 December 2012, were recruited for this study. All patients were treated surgically using the same surgical technique of fibrotomy followed by split skin graft along with a polyethylene stent. Preoperative and postoperative mouth opening measurements at 1 week and after a minimum of 6 months were evaluated by measuring the inter incisal distance.
Mean follow up was 9.8 months with a minimum of 6 months. Mean preoperative mouth opening was 12.9 mm (6-20 mm). Intraoperatively mean mouth opening was 37.9 mm (36-41 mm). After 1 week mean mouth opening was 35.8 mm (31-40 mm). At 6 months follow up, mean mouth opening was 33 mm (20-40 mm).
Fibrotomy followed by split skin graft along with a polyethylene sheet stent and sufficient postoperative physiotherapy is a simple, cost effective and viable treatment modality for oral submucous fibrosis.
