scholarly journals Surgical Treatment with Locoregional Flap for the Nose

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Marco Marcasciano ◽  
Mauro Tarallo ◽  
Michele Maruccia ◽  
Benedetta Fanelli ◽  
Giorgio La Viola ◽  
...  
Keyword(s):  
Functional Result ◽  
Tumor Control ◽  
Nasal Reconstruction ◽  
Local Defect ◽  
Common Site ◽  
Skin Cancers ◽  
Skin Loss ◽  
Nasal Region ◽  
Nasal Pyramid ◽  
Nasal Defects

Nonmelanotic skin cancers (NMSCs) are the most frequent of all neoplasms and nasal pyramid represents the most common site for the presentation of such cutaneous malignancies, particularly in sun-exposed areas: ala, dorsum, and tip. Multiple options exist to restore functional and aesthetic integrity after skin loss for oncological reasons; nevertheless, the management of nasal defects can be often challenging and the best “reconstruction” is still to be found. In this study, we retrospectively reviewed a total of 310 patients who presented to our Department of Plastic and Reconstructive Surgery for postoncological nasal reconstruction between January 2011 and January 2016. Nasal region was classified into 3 groups according to the anatomical zones affected by the lesion: proximal, middle, and distal third. We included an additional fourth group for complex defects involving more than one subunit. Reconstruction with loco regional flaps was performed in all cases. Radical tumor control and a satisfactory aesthetic and functional result are the primary goals for the reconstructive surgeon. Despite tremendous technical enhancements in nasal reconstruction techniques, optimal results are usually obtained when “like is used to repair like.” Accurate evaluation of the patients clinical condition and local defect should be always considered in order to select the best surgical option.

scholarly journals Clinical and histo-pathological aspects of the skin tumours in the nasal region

2016 ◽  
Vol 22 (2) ◽  
pp. 92-96
Author(s):  
C. Aftenie ◽  
I. Bordeianu
Keyword(s):  
Public Awareness ◽  
Squamous Cell Carcinomas ◽  
Skin Tumours ◽  
Cosmetic Appearance ◽  
Malignant Skin ◽  
Malignant Lesions ◽  
Nasal Region ◽  
Nasal Pyramid ◽  
Solar Radiation Exposure ◽  
Nasal Defects

Abstract Nasal pyramid presents an increased frequency of skin tumours such as basal cell or squamous cell carcinomas. That could be explained by the increased rate of solar radiation exposure. Fear of a malign skin disease have been rising public awareness of the danger of exposure to sunlight. However, the incidence of skin cancer is continuously increasing. The probability of developing a skin tumour increases with age. Typically, concern relates to the patient on the cosmetic appearance and on the malignant potential of the lesion. Nasal defects can take place most often after oncological procedures. Knowing the most common forms of benign and malignant skin tumours is crucial for a proper evaluation and therapeutic management. Particular importance should be given to those clinical issues that may raise suspicion of a malignant lesions turn. In this study we evaluated the incidence of nasal pyramid tumours. This included also the pathological aspect of nasal skin.

Reconstructive Approaches to Nasal Defects

2018 ◽  
Author(s):  
Michael L. Bentz
Keyword(s):  
Steroid Injection ◽  
Free Tissue Transfer ◽  
Nasal Reconstruction ◽  
Nasal Airway ◽  
Prosthetic Rehabilitation ◽  
Prosthetic Reconstruction ◽  
Skin Cancers ◽  
Laser Treatments ◽  
Nonmelanoma Skin Cancers ◽  
Nasal Defects

Nasal reconstruction is commonly performed for treatment of defects arising from excision of nonmelanoma skin cancers, although other tumors, trauma, or infection may also result in significant nasal deformities necessitating corrective surgery. Patients being evaluated for nasal reconstruction should have a functional assessment of airflow through both the internal and external nasal valves to determine the need for reconstructive maneuvers that will maintain or improve the nasal airway. Aesthetic considerations relate to which nasal subunits are missing and how local, regional, and sometimes free tissue transfer can be used to optimize the final appearance of the nose. Reconstruction must incorporate a plan for reestablishing nasal lining, support, and cover depending on which elements are missing. Postoperative considerations include the need for nasal splints and interventions to optimize nasal scarring and contour such as scar massage, steroid injection, and laser treatments. Patients who are not good candidates for autologous nasal reconstruction may be considered for prosthetic reconstruction. This review contains 13 figures and 67 references Key words: Nasal reconstruction, Nasal airway, Mohs surgery, Skin cancer, Nasal aesthetic subunits, Facial flaps, Skin graft, Forehead flap, Nasal cover, Nasal lining, Nasal support, Prosthetic rehabilitation

Reconstructive Approaches to Nasal Defects

2018 ◽  
Author(s):  
Ravi K Garg ◽  
Michael L. Bentz
Keyword(s):  
Steroid Injection ◽  
Free Tissue Transfer ◽  
Nasal Reconstruction ◽  
Nasal Airway ◽  
Prosthetic Rehabilitation ◽  
Prosthetic Reconstruction ◽  
Skin Cancers ◽  
Laser Treatments ◽  
Nonmelanoma Skin Cancers ◽  
Nasal Defects

Nasal reconstruction is commonly performed for treatment of defects arising from excision of nonmelanoma skin cancers, although other tumors, trauma, or infection may also result in significant nasal deformities necessitating corrective surgery. Patients being evaluated for nasal reconstruction should have a functional assessment of airflow through both the internal and external nasal valves to determine the need for reconstructive maneuvers that will maintain or improve the nasal airway. Aesthetic considerations relate to which nasal subunits are missing and how local, regional, and sometimes free tissue transfer can be used to optimize the final appearance of the nose. Reconstruction must incorporate a plan for reestablishing nasal lining, support, and cover depending on which elements are missing. Postoperative considerations include the need for nasal splints and interventions to optimize nasal scarring and contour such as scar massage, steroid injection, and laser treatments. Patients who are not good candidates for autologous nasal reconstruction may be considered for prosthetic reconstruction. This review contains 13 figures and 67 references Key words: Nasal reconstruction, Nasal airway, Mohs surgery, Skin cancer, Nasal aesthetic subunits, Facial flaps, Skin graft, Forehead flap, Nasal cover, Nasal lining, Nasal support, Prosthetic rehabilitation

Nasal Anatomy and Function

2017 ◽  
Vol 33 (01) ◽  
pp. 003-008 ◽  
Author(s):  
Ruchin Patel
Keyword(s):  
Complex Structure ◽  
Respiratory Physiology ◽  
Nasal Reconstruction ◽  
Facial Aesthetics ◽  
Basic Understanding ◽  
Nasal Anatomy ◽  
And Function ◽  
Nasal Function ◽  
Nasal Defects

AbstractThe nose is a complex structure important in facial aesthetics and in respiratory physiology. Nasal defects can pose a challenge to reconstructive surgeons who must re-create nasal symmetry while maintaining nasal function. A basic understanding of the underlying nasal anatomy is thus necessary for successful nasal reconstruction.

scholarly journals Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience

2014 ◽  
Vol 47 (03) ◽  
pp. 333-339 ◽  
Author(s):  
Rajeev B. Ahuja ◽  
Rajat Gupta ◽  
Pallab Chatterjee ◽  
Prabhat Shrivastava
Keyword(s):  
Informed Choice ◽  
Composite Graft ◽  
Nasal Reconstruction ◽  
Composite Grafts ◽  
Alar Base ◽  
Split Skin ◽  
Nasal Defects ◽  
Long Term Experience

ABSTRACT Introduction: Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients). Patients and Methods: Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm × 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months. Results: All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts. Conclusion: In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of ‘warm ischemia time’ for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of differing opinions that should facilitate a surgeon in making an informed choice.

The Bilobe Flap for Nasal Reconstruction

2020 ◽  
Vol 36 (03) ◽  
pp. 276-280
Author(s):  
Tyler S. Okland ◽  
Yu Jin Lee ◽  
Akshay Sanan ◽  
Sam P. Most
Keyword(s):  
Surgical Technique ◽  
Subcutaneous Tissue ◽  
Retrospective Chart Review ◽  
Nasal Reconstruction ◽  
Flap Reconstruction ◽  
Transposition Flap ◽  
Scar Revision ◽  
Facial Plastic ◽  
Ear Cartilage ◽  
Nasal Defects

AbstractRepair of nasal defects is technically challenging due to inelastic nasal skin and unforgiving nasal geometry. The bilobe flap is a double transposition flap that can transpose skin from cephalad to caudad to repair defects of the lower third of the nose. However, pincushioning may complicate this flap, yielding untoward aesthetic outcomes. We review our single surgeon series of patients who underwent bilobe flap reconstruction of nasal defects, and describe our surgical technique to minimize pincushioning and poor aesthetic outcomes. This was a retrospective chart review of patients who underwent bilobe flap reconstruction of nasal defects at a tertiary referral facial plastic and reconstructive surgery clinic between January 1, 2010 and February 12, 2019. All postoperative clinic notes were analyzed for complications, reports of unfavorable cosmetic outcome, and rates of revision procedures. Surgical technique is described. In the analysis, 125 patients were included, of whom 84 (67%) patients were women, and the mean (standard deviation) age was 60.7 (12.5) years. Complications were reported in 20 (16%) patients, including scars, pincushioning, and nasal obstruction. Five patients underwent revision surgery (4%), including scar revision and z-plasty. Pincushioning was reported in four patients (3.2%), of whom three underwent scar revision procedures. One patient had alar notching requiring correction. There was no statistically significant association between ear cartilage graft and complications (p = 0.84) or requirement of intervention (p = 1.0). Univariate and multivariate logistic regression did not show statistically significant association between size of the defect and the presence of complications (p > 0.05). The bilobe flap is an excellent transposition flap for the repair of small nasal tip defects. By adequately thinning the transposition flap of excess subcutaneous tissue prior to inset, rates of poor aesthetic outcomes, revision procedures, and pincushioning are minimized.

scholarly journals Clinical and Demographic Features of Basal Cell Carcinoma in North Jordan

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Firas Al-Qarqaz ◽  
Maha Marji ◽  
Khaldon Bodoor ◽  
Rowida Almomani ◽  
Wisam Al Gargaz ◽  
...  
Keyword(s):  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Basal Cell ◽  
Sun Exposure ◽  
Surrounding Tissue ◽  
Common Site ◽  
Skin Cancers ◽  
Retrospective Clinical Study ◽  
The Face ◽  
Religious Dress

Basal cell carcinoma (BCC) is the most common cancer affecting humans. It almost has no tendency for metastasis; however it can be destructive to surrounding tissue. Patients with darker skin colors have lower risk of developing skin cancers and the clinical characteristics may differ from populations with lighter skin colors.Methods. This is a retrospective clinical study (2003–2017). Data on age, gender, and location of tumor were collected and analyzed.Results. 335 cases were identified. Males tend to get BCC at a younger age than females. Face was the most common site in both males and females. Cheeks and nose were the most likely areas of the face to be involved. Scalp was the most common extrafacial site to be involved in males; however in females scalp was much less likely to be involved.Conclusion. BCC is less common in populations with darker skin. Males were more affected and at an earlier age compared to females. Facial skin followed by scalp was the most common site affected. Skin phototype, cultural and religious dress type, and different sun exposure behavior may explain many of the clinical and demographic findings related to BCC in patients with darker skin tones.

Dermabrasion and Nasal Reconstruction

1995 ◽  
Vol 9 (2) ◽  
pp. 85-94
Author(s):  
James L. Rossiter ◽  
Brian P. Maloney ◽  
Daniel E. Rousso ◽  
E. Gaylon McCollough
Keyword(s):  
Treatment Options ◽  
Nasal Reconstruction ◽  
Anatomical Site ◽  
Reconstructive Procedure ◽  
Common Procedure ◽  
Reconstructive Procedures ◽  
Ablative Surgery ◽  
Facial Plastic ◽  
Acne Scarring ◽  
Nasal Region

Facial plastic surgeons perform various reconstructive procedures in the nasal region following trauma and ablative surgery. Occasionally these procedures lead to postoperative scarring and contour deformities. Although dermabrasion has been used extensively in the nasal area as a treatment for acne scarring, its role as an adjunct for the refinement of primary procedures in this prominent region is often overlooked. Dermabrasion is invaluable as an ancillary tool for the treatment of localized irregularities following nasal reconstruction. In a retrospective study of patients’ records from 1989 to 1992, 55 nasal reconstructive procedures were performed on 44 patients; 19 of these patients underwent postoperative dermabrasion. The most common procedure requiring dermabrasion was local flap reconstruction. Dermabrasion was also used as the primary reconstructive procedure for eight additional patients. A summary and discussion of the primary procedures, anatomical site, indications, timing, technique, postoperative course, and complications of dermabrasion following nasal reconstruction is included. In addition, the special anatomical and technical considerations and general indications for dermabrasion in the nasal region are addressed, as well as other available treatment options.

Rationale and Argument for Subunit Mohs Excision in Nasal Reconstruction

2016 ◽  
Vol 20 (4) ◽  
pp. 343-345
Author(s):  
Zachary R. Jergensen ◽  
Ronnie A. Pezeshk ◽  
James F. Thornton
Keyword(s):  
Functional Results ◽  
Nasal Reconstruction ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Nasal Ala ◽  
Aesthetic Results ◽  
Nasal Defects

Background: Optimal aesthetic results are achieved when nasal defects after Mohs micrographic surgery (MMS) are reconstructed as entire nasal subunits. Objective: To illustrate the importance of reconstructing the nose in entire subunits and explore the possibilities of expanding the principles of subunit reconstruction to the concept of subunit Mohs excision. Methods: An 83-year-old man presented for MMS to excise 3 lesions on the nasal ala. The surgeons elected to excise and reconstruct the entire subunit. Results: Excellent aesthetic and functional results were obtained. Conclusion: When a defect greater than 50% of a nasal subunit is encountered during MMS, immediate marginal control excision of the entire subunit can be performed with subsequent reconstruction. This technique ultimately has the potential to deliver a more aesthetically pleasing outcome and should be, at the very least, considered by all Mohs surgeons.

scholarly journals The use of folded melolabial interpolation flaps to repair full thickness distal nasal defects: A review of technique and results

2016 ◽  
Vol 1 (3) ◽  
Author(s):  
Eamonn Maher ◽  
Scott Walen ◽  
Ian Maher
Keyword(s):  
Cartilage Graft ◽  
Full Thickness ◽  
Forehead Flap ◽  
Common Site ◽  
Paramedian Forehead Flap ◽  
Surgical Teaching ◽  
Mucosal Lining ◽  
Cutaneous Flap ◽  
Surgical Options ◽  
Nasal Defects

<p>The nose is a common site for skin cancer and there are several surgical options available for reconstruction after excision. Traditional surgical teaching suggests that in the case of a partial full thickness defect involving the distal nose or ala, a paramedian forehead flap (PMFF) or an intranasal lining flap with free cartilage graft and additional cutaneous flap should be performed. However, each of these options comes with unique disadvantages. The incision and pedicle required for the PMFF can be unsightly and functionally limiting, while the intranasal lining flap is technically challenging and can obstruct the nostril. Herein, we review our experience with a two-stage folded-over melolabial interpolation flap (MLIF) to repair partial full thickness defects of the distal nose and ala in order to recreate the cutaneous covering, nasal rim, and inner mucosal lining.</p>

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