THU524 Combination Of Mustardé Cheek Advancement Flap And Paramedian Forehead Flap As A Reconstructive Option In Basal Cell Carcinoma Of The Nose: A Functional And Aesthetic Alternative

Abstract

Abstract Disclosure: A.P. Solis Pazmiño: None. C. Rocha: None. E. Pilatuna: None. R. Godoy: None. C. Garcia: None. Background: Defects resulting from the surgical procedure due to basal cell carcinoma (BCC) may be challenging to reconstruct depending on the size and location. In moderate to large-sized defects, especially in face lesions, a combination of more than one type of flap might be necessary. We present a patient with a large BCC in the nasal region which was successfully closed using a combination of rotation and advancement flaps. The patient showed excellent functional and cosmetic outcomes. Clinical Case: An elderly woman presented to our center with a five-year history of a persistent nasal vestibular lesion. It was treated with multiple cauterizations without a total improvement, until then. There was no associated pain, bleeding, or drainage. She denied family history, risk factors, or systemic diseases associated with this skin pathology. Physical examination revealed a 4 cm x 3 cm desquamated plaque with multiple pustules and a small deep ulcered area on the left nasal vestibule and overlying telangiectasia. A skin biopsy confirmed the clinical suspicion that this patient had nodular basal cell carcinoma (BCC), also known as rodent ulcer. The patient underwent surgery and we sent an intraoperative frozen section (IFS), 6 margins were taken in 10 mm strips each, and two of the seven tissue samples were reported positive. Made do with a double scalpel blade numbered by segments following clockwise order.Meanwhile, the defect reconstruction was done after histopathological examination confirmed tumor-free margins. A local skin flap, a paramedian forehead flap, transferred full-thickness skin and subcutaneous tissue into the surgical defect, which maintained the local blood supply via a vascular pedicle that remained connected to the donor site. Then, the advancement bilateral flap (Mustardé) was slid into the defect where the incisions were made tangentially to the defect to free neighboring tissue, with the wound edge acting as the free margin of the flap. Finally, for the frontal opening graft tissue, we used a pressure dressing on cutaneous grafts using a gauze wad (Brown Curative). Clinical lessons: This case exposes basal cell carcinoma (BCC), the most common skin malignancy with a predilection on sun-exposed areas such as the face. The surgical technical selected was a combination of skin flap techniques such as paramedian forehead flap, and the cheek rotational (Mustardé) flap showed excellent functional and cosmetic outcomes. Also, the oncological accepted margins depend on the risk group and the tumor size. For primary well-demarcated BCCs smaller than 2 cm, in the low-risk group, a safety margin of 3 mm gives satisfactory results. Presentation: Thursday, June 15, 2023