Two Suturing Techniques for the Prevention and Treatment of Nasal Valve Collapse After Mohs Micrographic Surgery

Abstract

The 3-point stitch and the modified suspension suture techniques are easy and simple methods that can be incorporated into reconstruction after MMS for defects of variable depth covering any multisubunit perialar region to prevent or correct INV collapse.

Combination Nasal Sidewall and Alar Defects

“…Cartilage grafts can help prevent internal nasal valve collapse but add additional costs and wound care for patients. 1 Local skin flaps offer reliable blood supply and excellent tissue match; therefore, nasal reconstructions with flaps may more often yield superior results. Interpolation flaps may provide the best option for deep alar defects.…”

Nasal Obstruction after Mohs Surgery: Prevention and Correction

“…13,15 In addition to structural grafting, several suturing techniques have been described that, when performed at the time of post-MMS nasal reconstruction, have shown to have high rates of success in preventing nasal valve collapse and subsequent nasal obstruction. 30,31 Miladi et al describe a three-point suture used for patients with MMS defects overlying the alar groove. 30 The first point of this suture encompasses the alar groove soft tissue overlying the INV, with the second and third points including the medial and lateral edges of the overlying dermis of the repair, respectively.…”

“…30,31 Miladi et al describe a three-point suture used for patients with MMS defects overlying the alar groove. 30 The first point of this suture encompasses the alar groove soft tissue overlying the INV, with the second and third points including the medial and lateral edges of the overlying dermis of the repair, respectively. Similar in concept, a modified suspension suture has been described by Wang et al 31 In this technique, a suture is passed through the nasal tissue at the point of greatest depression-which, depending on the defect, can be located in fibrofatty tissue, lateral cartilage, or the transverse nasalis.…”

Commentary on “How We Do It: Guiding Curvilinear Repair With Partial Secondary Intention Healing for Reconstruction of Mohs Defects of the Alar Groove”

“…Two of these techniques are the 3-point stitch and the modified suspension suture. 3 In the 3-point stitch technique, 3 key sutures are placed in the following locations: the soft tissue of the alar groove overlying the nasal valve and the medial and lateral edges of the overlying dermis. This allows for anterior tenting of the tissue, opening the internal nasal valve.…”

“…The modified suspension suture technique anchors a suture in the maxillary periosteum allowing for anterior and superior lateral pull of the nasal sidewall tissue, widening the internal nasal valve. 3 Both of these repair techniques can help achieve the ultimate goal of appropriate functional and cosmetic outcomes for the patient. Indeed, both of these techniques can be used at the time of initial reconstruction to prevent subsequent nasal valve compromise.…”