“THUNDER – LIKE” PLASTY FOR TWIN NASAL TIP DEFECTS. TECHNIQUE DESCRIPTION AND INDICATIONS

Abstract

​INTRODUCTION: Reconstructive approaches to nasal tip defects are always challenging to perform, depending on the age of the patient, shape of the nose, local anatomy and adjacent structures. Many techniques have been described, each one with its advantages and limitations. AIM: Our aim is a new technique description designed for the reconstruction of twin defects of the nasal tip. The decision-making, the step-by-step description, and its application to a male patient are explained in detail. MATERIAL - METHOD: A 61 years old male patient was referred to our department with two benign lesions of the nasal tip. Due to their proximity, a simultaneous excision was planned in a way that allowed both adequate excision and minor defect dimensions. The remaining defect was reconstructed with a combination of 2 rotation flaps and 2 V-Y plasties. RESULTS: Very good skin match (color and texture). Suture lines are barely detectable because they are buried in the anatomical border between the nasal tip and the alar area. No consequences for the alar shape or the columella are mentioned (deviation, stricture, narrowing or flattening respectively). CONCLUSION: This technique has been influenced by the “East – West plasty”. Its innovative elements are: 1. The upper triangle hereafter contains the second lesion. 2. The V-Y plasties we intendedly added on top of each rotation flap limit loss of length resulting in well aligned scars. The technique is advisable for benign lesions, in situ malignancies or for centers performing Mohs micrographic surgery.