Abstract

Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose.

Highlights

  • The most common site of facial skin cancer is the nose (25.5%), because of its cumulative exposure to sunlight [1,2,3]

  • We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery

  • Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision

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Summary

Introduction

The most common site of facial skin cancer is the nose (25.5%), because of its cumulative exposure to sunlight [1,2,3]. Primary squamous cell carcinomas (SCCs) require 4.0-mm margins for low-risk tumors and 6.0 mm margins for high-risk tumors (≥2.0 cm; >II histological grade; nose, lip, scalp, ears, eyelids; invasion into the subcutaneous tissue) to obtain a 95% cure rate [4, 6]. For these tumors, Mohs micrographic surgery offers improved cure rates, as it is a technique that allows for complete microscopic control of tumor removal in addition to superior tissue preservation. After tumor-free margins on frozen section have been established, reconstruction of the surgical wound can be performed with confidence

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