Pushing the Perialar: A Modified Perialar Crescentic Advancement Flap for the Reconstruction of Large Nasal Sidewall Defects

Background:Basal cell carcinoma of the nose is common, with a potential of local recurrence and high-risk features.Materials and Methods: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.Results: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.Conclusions: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.

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“…The primary movement is here in a horizontal line and the scar is concealed in the junction line. [ 23 ]…”

Section: Introductionmentioning

confidence: 99%

Basal cell carcinoma of the outer nose: Overview on surgical techniques and analysis of 312 patients

Wollina¹,

Bennewitz²,

Langner³

2014

J Cutan Aesthet Surg

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“…The PACA may on occasion need to extend a considerable distance around the alar groove to the alar base. A recently described modification of the technique not only allows sufficient movement but better hides the scars in the alar groove (Fig. ).…”

Section: Reconstructive Optionsmentioning

confidence: 99%

Reconstructing the nasal dorsum

Vinciullo¹

2014

Br J Dermatol

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The skin of the nasal dorsum and bridge is more forgiving in terms of reconstructive options. Individual differences in skin laxity, nasal length and sebaceous composition impact on reconstructive choice as do the size, depth and exact location of the surgical defect. For many, if not all, defects in this area there are multiple different reconstructive options available all of which can result in equivalent and excellent results. Oftentimes there is no clear advantage of one repair over another and the choice becomes one of personal preference based on experience. No proscriptive approach or algorithm can be usefully applied in this setting. Key considerations include the location of the defect (distal vs. proximal nasal dorsum), the position of the defect (midline or off-centre) and the texture of the skin involved (sebaceous vs. non-sebaceous). Defects may be considered complex if they border on, or cross onto adjacent cosmetic units. Examples include defects extending onto the nasal tip, tip-ala junction, sidewall, nasal root-glabella and medial canthus. The adjacent reservoirs of tissue redundancy that can be utilized in flap reconstruction include the nasal sidewall, the nasal dorsum itself, the glabella, the midline/paramedian forehead and the medial cheek. Nearly all flaps on the nasal dorsum require subnasalis muscle dissection to effect sufficient movement and to ensure adequate flap vascularity and viability. The nasal bridge and glabella have much thicker skin and it is usually sufficient to dissect in the subcutaneous plane rather than disrupting the deeper procerus and corrugator muscles. Thick sebaceous skin is generally stiffer, moves less easily and closures may result in greater wound tension. These factors together with a tendency for sutures to tear through easily potentially increases the risk of complications. Greater consideration should be given to the exact type of flap or graft chosen in these patients.

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“…For defects on the lower sidewall larger than 1·5 cm in horizontal dimension, sliding flaps can be of great utility. The modified perialar crescentic advancement (PACA) flap provides a simple yet effective method of closure even for defects over 20 mm in size (Fig. ).…”

Section: Regional Approaches To Sidewall Repairmentioning

confidence: 99%

“…(a) A modified perialar crescentic advancement flap after B orchard et al . is designed for closure of a 1·5 × 1·5‐cm defect after M ohs excision of a squamous cell carcinoma on the sidewall.…”

Section: Regional Approaches To Sidewall Repairmentioning

confidence: 99%

Repair of the nasal sidewall

Salmon

2014

Br J Dermatol

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Repair of the nasal sidewall after skin cancer excision is generally best approached with the use of local flaps for aesthetic reasons. The sidewall may be divided into upper and lower sections and defects described as small, medium or large. In this section I will review the flaps that I feel make best use of adjacent tissue reservoirs allowing aesthetic placement of incisions while protecting free margins and function, and that reward the operator with reliably superior results for the patient.

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Pushing the Perialar: A Modified Perialar Crescentic Advancement Flap for the Reconstruction of Large Nasal Sidewall Defects

Cited by 8 publications

References 5 publications

Basal cell carcinoma of the outer nose: Overview on surgical techniques and analysis of 312 patients

Basal cell carcinoma of the outer nose: Overview on surgical techniques and analysis of 312 patients

Reconstructing the nasal dorsum

Repair of the nasal sidewall

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