Revisiting Nasal Reconstruction After Mohs Surgery

Abstract

Introduction Nasal reconstruction after oncologic resection often constitutes a technically demanding task. The aim of this study was to investigate our experience with nasal reconstruction after Mohs micrographic surgery using the following 3 well-established, versatile, and reliable techniques: the bilobed flap, nasolabial flap, and forehead flap. Methods A single-surgeon retrospective chart review of all patients undergone a bilobed, nasolabial, or forehead flap for nasal reconstruction after Mohs micrographic surgery from 2003 to 2017 was conducted. Data collected for analysis included demographics and defect characteristics. Revisions and complications were analyzed. Results A total of 83 patients were included in the study; 52 patients underwent bilobed, 17 patients nasolabial, and 14 patients forehead flaps. All defects involved the middle and lower nasal zones. There was a significant difference in the defect size between the 3 groups (P < 0.001). The mean diameters were as follows: 1.37 cm for the bilobed, 2.22 cm for the nasolabial, and 3.46 cm for the forehead flap groups. Liberal utilization of the bilobed and nasolabial flaps achieved reconstruction of defects larger than typically described in the literature. Reconstruction of all defects, including support for successful restoration of mucosal lining and cartilage when indicated, was achieved. An algorithm dealing with defects larger than 0.5 cm in the middle and distal nasal zones was devised. Conclusions In this study, the liberal application of the 3 flaps was described based on an individualized treatment approach. The algorithm provides a simplified approach for larger nasal defects in the middle and lower thirds.

Postoperative Complications After Interpolated Flap Repair for Mohs Defects of the Nose: A Multicenter Prospective Cohort Study

“…Surgical site infection (SSI) after interpolated flap repair occurred in 4.14% (7/169, 95% CI: 2.02%-9.82%) of patients after flap placement and 2.96% (5/169, 95% CI: 1.27%-6.74%) of patients after flap takedown. Retrospectives studies from single centers 9,10,14,16,17 and a claims database study 13 have reported similar rates of SSI, ranging from 1% to 5.9% after interpolated flap repair. Of note, 76% and 52% of patients in this prospective cohort received prophylactic antibiotics at flap placement and flap takedown, respectively.…”

Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap

“…The donor scar is well hidden to the nasolabial fold. 5 However, the main drawback of the flap is the frequent requirement of a second-stage surgery; even when it is transferred in a subcutaneous island flap fashion. The nasolabial perforator flap overcomes this disadvantage and provides closure in a single stage.…”

“…Similar propeller flap articles describe reconstruction of difficult medial canthal defects, alar defects, and lateral nasal defects using various propeller flaps based on supratrochlear arteries, facial artery perforators, and central arteries. [3][4][5][6][7] The common unifying theme of all these reconstruction options is that they provide definitive coverage in one stage rather than multiple stages. 8 I applaud the authors for adding to the literature in a topic that has been one of the oldest and best-studied topics in Plastic Surgery.…”

“…Conventional nasolabial flap is able to provide “like with like” thick skin for reconstruction of caudal third of the nose. The donor scar is well hidden to the nasolabial fold 5 . However, the main drawback of the flap is the frequent requirement of a second-stage surgery; even when it is transferred in a subcutaneous island flap fashion.…”

A Novel Repair Idea on Nasal Sidewall Defect in Asians: Local Tissue Regeneration

“…In addition, the modified rhomboid flap adjacent to the defect of the nasal sidewall is often used to repair small defects of skin soft tissues because of its proximity to the defect, and its skin color and texture similar to those of the defect. 7 A few scholars have also used skin graft to reconstruct the small defects on the nasal FIGURE 1. A 34-year-old woman with nasal sidewall tumor (diameter approximately of 7 mm) was excised and underwent the natural tissue regeneration.…”