Aesthetic Outcomes of Nasal Burow's Grafts With Interdomal Sutures After Mohs Micrographic Surgery

Abstract

BACKGROUND Post-Mohs reconstruction of distal nasal defects is challenging. Many repair options exist, each with advantages and disadvantages. Utilization of a Burow's graft in combination with manipulation of the underlying nasal cartilages with interdomal sutures is an underreported yet effective repair option. OBJECTIVE To present the authors' experience with Burow's grafts facilitated by interdomal sutures for repair of nasal defects after Mohs micrographic surgery (MMS). MATERIALS AND METHODS Patients who underwent repair with Burow's grafts and interdomal sutures from 2013 to 2017 at a single university were identified. Demographics, follow-up, and complications were recorded. Two independent, board-certified dermatologists evaluated photographs for cosmesis and alar symmetry. RESULTS Thirty-one patients were identified. A total of 5/31 patients (16.1%) experienced minor complications without permanent sequelae. A total of 4/31 (12.9%) patients underwent cosmetic revision. No incidences of pincushioning, nasal valve dysfunction, or graft necrosis occurred. Aesthetic ratings were good to excellent with mean visual analog score of 80.8. Alar symmetry was excellent. CONCLUSION A Burow's full-thickness skin graft facilitated by an interdomal suture to maintain nasal tip orientation and projection is an elegant repair technique for distal nasal oncologic defects with good to excellent aesthetic outcomes. It should be considered in the armamentarium for repair of distal nasal defects after MMS.

Interdomal Suture: Maintaining Nasal Tip Projection With East–West Advancement Flap Repairs

“…Although this technique is well-known to plastic surgeons and otolaryngologists who perform rhinoplasties, there are limited data in the dermatology literature. 3,5 Previous reports of this neoadjuvant technique followed by Burow's full-thickness skin grafts demonstrate low complication rates and a reduced need for revision due to preservation of symmetry and overall long-term cosmesis. 3 To the authors' knowledge, the use of this adjuvant technique with E-W flaps has not been previously described in the literature.…”

“…Although historically used as a rhinoplasty technique, the interdomal suture (IDS) has been described as a simple adjuvant to Burrow's grafting for preservation of nasal tip projection after MMS. 3 The authors have found the IDS similarly useful and effective when paired with E-W advancement flaps.…”

Cheek Donor Site for Full-Thickness Skin Graft Repair of the Nasal Ala: Outcomes of a Retrospective Cohort Study

“…4 The ultimate goal of defect reconstruction is to maximize the esthetic outcome with excellent texture and color matching while maintaining function of the airway. 5 Full-thickness skin grafts (FTSGs) are one of the most efficient and commonly used closure options for defects on the nasal ala. 6 Donor sites for FTSGs are selected based on tissue match, which includes color, thickness, actinic damage, and sebaceous quality of the skin. Common donor sites for nasal repair include the preauricular, postauricular, supraclavicular, clavicular, conchal bowl, and glabellar areas.…”

“…4 The ultimate goal of defect reconstruction is to maximize the esthetic outcome with excellent texture and color matching while maintaining function of the airway. 5 Full-thickness skin grafts (FTSGs) are one of the most efficient and commonly used closure options for defects on the nasal ala. 6…”