28284 Subcutaneous hinge flaps: A great choice, especially in the setting of COVID

Abstract

A 55-year-old woman presented for Mohs surgery with an infiltrative basal cell carcinoma of the nasal dorsum with a preoperative size of 0.9 cm × 0.7 cm. Negative margins were achieved after five stages, and the resultant defect measured 2.6 × 2.4 cm with exposed cartilage and involvement of 4 subunits of the nose (Figure 1). For large nasal tip defects, a paramedian forehead flap (PMFF) is nearly the gold standard. These flaps are chosen due to good color match between the donor forehead skin and the nose, the presence of sebaceous tissue within the flap, and the ability to match the flap depth to the depth of the defect. Our patient was offered a paramedian forehead flap and adamantly declined, citing her inability to care for the flap. Instead, she elected for a two-stage repair of a subcutaneous hinge flap from the upper nasal dorsum to restore the contour and depth of the nasal tip and supratip, to cover the exposed cartilage, and to provide good blood supply for the subsequent full thickness skin graft performed during the second stage of repair. She had excellent take of the FTSG and was pleased with her result. Several months after the surgery, the area was lightly dermabraded and then treated with several pulse dye laser treatments with good cosmesis. This repair option is especially important during COVID times, when a PMFF would minimize the ability to function in society and to safely wear a mask.