Glabellar Flap Research Articles

How We Do It: The Glabellar Hatchet Flap for Reconstruction of the Proximal Nasal Side Wall and Medial Canthus.

How We Do It: The Glabellar Hatchet Flap for Reconstruction of the Proximal Nasal Side Wall and Medial Canthus.

Role of Glabellar flap in midfacial reconstruction.

Aims: Reconstruction of midface always poses a challenge to a Plastic surgeon as one has to address the convexities and concavities which are somewhat unique to this area. Various local flaps have been used for achieving these goals. This study was conducted to evaluate the indications, feasibility and outcome of midfacial reconstruction using Glabellar flaps at a tertiary care center.
 Materials and Methods: This is a prospective observational study conducted in the Department of Plastic and Reconstructive Surgery of a tertiary care hospital between January 2016 to December 2019. All the patients who underwent midfacial reconstruction with Glabellar flaps during this period and consented to be a part of this study were included. Patient demographics, wound etiology and area, flap size and its mode of transfer, number of surgeries required, type of anesthesia used, comorbid conditions, complications if any and the results of reconstruction were recorded. All the patients were followed up till May 2020.
 Results: Thirteen patients were managed with Glabellar flaps. Majority of the patients (n=9, 69.23%) were males, with a mean age of 34 years. Most common cause of wounds was animal bite/maul (n=5, 38.46%). Glabellar flap was most commonly used as V-Y rotation advancement flap in nine patients (69.23%). Most of the cases (n=9, 69.23%) was operated under local anesthesia. Donor site was closed primarily in V-Y or linear fashion in 12 cases, and skin grafted only in 1 case. Majority (n=12, 92.3%) of the patients graded reconstruction results as Good-Excellent.
 Conclusions: Glabellar flap is an excellent option for reconstruction of midfacial defects with minimal donor site morbidity and can be performed safely under local anesthesia.

Clinico-pathological Analysis of Malignant Eyelid and Adnexal Tumors Presenting to a Tertiary Eye Hospital Of Eastern Nepal

Introduction: Eye lid and adnexal tumours are one of the major problems we see in the oculoplastic department. Malignant eye lid tumours are rare in comparison to benign and diversity in its clinical presentation makes it difficult to diagnose earlier. Eyelid malignancies can mimic a host of benign neoplasms and other less aggressive neoplastic or non-neoplastic inflammatory conditions and need differentiation before definitive therapy is planned. Out of 90% of all skin cancer occurring in head and neck region 10% occurs in the eyelid. A histopathological study confirms the diagnosis that can be correlated with patient history and other clinical data.
 Objectives: To study the clinicopathological correlation and its outcome in patients with malignant eyelid and adnexal tumours presenting at Biratnagar eye hospital.
 Methodology: Details of the cases of histopathologically proven malignant eyelid and adnexal tumours presenting to the department of oculoplasty from July 2016 to August 2019 were recorded. The duration of disease, presenting symptoms, risk factors, demographic data, clinicopathological correlation with its accuracy and mode of treatment were analyzed using SPSS 17.
 Results: Out of total 28 patients, male were 53.6% and female were 46.4%. The mean age of presentation was 60.5±11.8 years. 53.6% tumors were located in upper lid, 39.9% were located in lower lid and 7.1 % were located in medial canthus. Basal cell carcinoma and sebaceous gland carcinoma were the most common type of malignancies (35.7% each) followed by 28.6% of squamous cell carcinoma of eyelid. The clinicopathological correlation revealed 75% of clinical accuracy. Different types of reconstructions were done according to the size and site of the defect. Modified Hughes procedure for lower eyelid defect was the most common procedure performed (32.1%), followed by 14.3% Cutler beard, 28.6% Cutler beard with post auricular cartilage graft, 10.7% Glabellar flap rotation 7.1% had combined procedure and 4.3% direct closure .
 Conclusion: Sebaceous cell carcinoma and Basal cell carcinoma were the most common malignant tumors followed by squamous cell carcinoma. The upper lid was the most common site for such malignancy. Histopathological examination was useful for the establishment of complete and accurate diagnosis, which led to further management and follow up protocol for malignant eyelid tumours.

Clinical effects of nasal glabellar flap on reconstruction of nasal dorsal and tip

Objective To introduce an excellent one-stage procedure for repairing defects of the middle and distal part of the nose: nasal dorsal glabellar flap. Methods According to the size, shape and location of nasal defect, homologous nasal dorsal glabellar flap was selected to cover the nasal defect in 17 cases. Among 17 cases, there were 7 men and 10 women, with age of 38 to 76 years. The locations were nasal tip in 9 cases and dorsum of nose in 8 cases, The area of the defect ranged from 15 mm×15 mm to 30 mm×26 mm. The nasal dorsal glabellar flap, which received a versatile axial blood supply from branches of the facial artery and ophthalmic artery, took tissue from the lax glabellar skin and might appear to be too aggressive for closure of a distal nasal or mid-nasal defect. However, because its design was primarily that of a rotation flap with a back-cut in the glabella region, it was greater than the primary defect in order to maximize tissue movement and decreased wound closure tension at the flap donor site. The secondary defect of donor site was directly sutured. Results The nasal defect was successfully repaired in all patients, and the all flaps survived. The patients were available for follow-up of 1 to 6 months, no tumor recurrence occurred, and the repaired tissue were good match with surrounding tissue in color, thickness and texture, good nasal contour was obtained and no secondary deformity occurred, and therefore the cosmetic results were satisfactory. Conclusions The nasal glabellar flap has evolved into a choice flap for nasal defects of cover since it provides local skin with an exact color, thickness, and texture match for the nasal skin. It allows large reconstructions for up to 30 mm defects leaving minimal scars. It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose. Key words: Nose; Skin; Reconstructive surgical procedures; Surgical flaps; Nasal glabellar flap; Defects

Surgical Correction of Tessier No. 4 Facial Cleft by Tessier Technique Using Multiple Z-plasty and Glabellar Flap: A Case Report

Surgical Correction of Tessier No. 4 Facial Cleft by Tessier Technique Using Multiple Z-plasty and Glabellar Flap: A Case Report

Reconstruction of Basal Cell Carcinoma over Face by Facial Flaps –Study of 30 Cases

Background: Basal cell carcinoma (BCC) is the most common skin cancer.85% of BCC are located in the head and neck area, of which 30% on the nose. After excision of BCC on the face, the options of treatment for a skin defect are variable. Many surgeons prefer to use a local flap rather than skin graft or free flap for small or moderately sized circular defects after excision of BCC on the face.Methods: All of the patients were histopathologically diagnosed as Basal cell carcinoma, thirty patients underwent various flaps like V-Y advancement flap, bilobed flap, forehead flap, nasolabial flap, glabellar flap repair over 3 years, between January 2014 to December 2016. We observed post-operative complications as flap loss either partial or complete, wound dehiscence, hematoma and wound infection and recurrence of carcinoma. The cosmetic outcome of the face also evaluated.Results: There were 19 men and 11 women. The age ranged from 48 to 73 years with a mean age of 62 years. The causes were BCC in all cases. The tumour locations were the face in all patients. All of the flaps survived, but in one case recurrence of BCC occur, which was managed surgically. Post-operative recovery was very nice.Conclusions: Our study shows facial flaps give nice result and first choice for facial reconstruction in BCC of face. Most defects can best closed by various facial flaps and outstanding functional and cosmetic results can be achieved.TAJ 2017; 30(2): 20-25

Glabellar Rejuvenation in Forehead Lift: Reversed Periosteum or Dermal Fat Graft to Cover Pedicled Glabellar Flap.

Forehead aging is characterized by wrinkles, loss of skin elasticity, brow ptosis, and soft-tissue atrophy. For patients with prominent rhytids and marked brow ptosis, forehead lift is still the most effective treatment with a persisting result. In order to eliminate the glabellar wrinkles, forehead lift usually requires the removal of the corrugator supercilii muscle and procerus, which can lead to glabellar flattening or depression. Instead of muscle removal, the corrugator supercilii muscle, procerus, and the underlying galea were dissected as a pedicled glabellar flap. Then reversed periosteum or dermal fat graft was used to cover the glabellar flap to restore the glabellar volume. From January 2005 to November 2014, a total of 164 coronal and 42 trichophytic forehead lifts were performed. Reversed periosteum was used to cover the glabellar flap in 191 patients while dermal fat graft was applied in 15 patients with a follow-up period ranging from 6 months to 10 years. There was no irregularity or depression in the glabellar region in the group of reversed periosteal flap. The take of dermal fat graft placed over the glabellar flap was minimal. Complications from surgical procedures occurred in 2.91% of the patients. There was 1 asymmetry, 4 patients with higher than desired frontal hairline for implantation of autologous follicular units, and 1 patient with scar hyperplasia. There was no hematoma or nerve injury, no permanent numbness, and no alopecia. The techniques are simple and effective to eliminate the glabellar wrinkles and maintain or restore the glabellar volume.

Reconstrucción nasal con colgajos locales: Manejo según unidades estéticas.

Introducción: Las lesiones neoplásicas de la nariz necesitan una resolución con resultado estético satisfactorio. El objetivo del presente estudio es realizar una descripción del lugar en donde se ubicaron las lesiones y los tipos de colgajos más utilizados. Métodos: El presente estudio descriptivo fue realizado en pacientes intervenidos en el 2013 por reconstrucción nasal secundaria exéresis tumoral en Solca-Guayaquil. Se describe la localización de la lesión y la técnica. La muestra fue incidental. Para la descripción se dividió la nariz en 3 zonas: proximal (Z1), media (Z2) y distal (Z3). Las lesiones con >1 zona fueron “defectos complejos”. Las Z1 y Z2 fueron divididas en subunidades (SU) central y lateral. La Z3 fue dividida en SU: alar, domo-alar, de domo, central, columelar y de base nasal. Los defectos con >1 SU fueron combinados. Resultados: Ingresaron al estudio 96 casos, 60 mujeres. 14 defectos (14.6 %) en Z1, 16 defectos (16.7%) en Z2, 50 casos (52 %) en Z3 y 16 defectos complejos (16.7 %). El colgajo frontal (CF) 21 casos (21.88 %), el colgajo avance V-Y (AV-Y) 19 casos (19.79 %) y el colgajo nasolabial (CNL) 15 casos (15.63 %). En Z1, la SU- central se utilizaron los colgajos glabelar (CG), AV-Y y colgajo en Mitra (CM); en la SU- lateral se utilizaron el CG y AV-Y con más frecuencia. En la Z2, la SU- central se utilizaron los CM y el cierre directo (CD); en la SU- lateral se utilizaron el CD, CM, AV-Y y CNL. En la Z3 se utilizaron CNL, AV-Y y colgajos bilobulados. El colgajo frontal fue usado en los defectos complejos y combinados. Conclusión: La SU-Alar y la SU del Surco Domal Alar de la Z3, fueron las áreas más prevalentes. Las técnicas quirúrgicas más utilizadas fueron, el colgajo frontal, el AV-Y y el CNL.

Medial canthal reconstruction with multiple local flaps

BackgroundIt is often difficult to reconstruct comparatively large defects in the medial canthal region. The authors have performed reconstruction with multiple local flaps in 4 medial canthal defects after resection of malignant skin tumors. MethodThe defects exceeded the medial canthal region, extending to the upper eyelid and the lower eyelid. The medial canthal defect was covered by transposition of a glabellar flap, the upper eyelid defect was covered by an upper eyelid myocutaneous advancement flap, and the lower eyelid defect was covered by a cheek rotation flap. Then the donor site of the glabellar flap was covered by a Rintala flap. ResultsThere was no recurrence in any of the cases, and good results were obtained. One case showed mild linear contracture, but the patient did not want corrective surgery. ConclusionThis method is somewhat complicated compared to reconstruction with a single flap, but it is a combination of standard local flaps and is a simple reconstructive procedure. By adding additional resection, the suture line is consistent with the border of the facial unit, so postoperative scarring is inconspicuous. This technique is aesthetically useful because of the continuity of colour and texture resulting from the use of adjacent flaps.

Reconstruction Techniques of Choice for the Facial Cosmetic Units

Background and objectivesA broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units. Material and methodsThis was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second. ResultsThe total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip. ConclusionsThe results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.

Técnicas reconstructivas de elección por unidades estéticas faciales

Background and objectivesA broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units. Material and methodsThis was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second. ResultsThe total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip. ConclusionsThe results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.

Reconstruction de la racine du nez après exérèse carcinologique profonde. Intérêt de combiner implants de titane et greffe de tissu graisseux

The mucosal cylindroma or adenoid cystic carcinoma is the second sinonasal non-epithelial malignant tumor frequency argument. Due to the achievement of the nasal mucosa and a late diagnosis reconstructions are often complex. We report the case of a mucous cylindroma recurrence of nasal septum requiring a wide and deep excision of the root of the nose with nasal reconstruction. A patient aged 66years whose history resection two years ago with a mucous adenoid cystic carcinoma of the right side of the nasal septum, had a local recurrence T2NOM0 imposing a wide excision with amputation nasal septum own bones of nose, the anterior portion of the triangular cartilages. The reconstruction was carried out in three areas: a musculocutaneous forehead flap to the mucosal level, a titanium plate to the bone plane, nasal native skin to skin level. Histological examination confirmed the existence of a recurrence cylindroma infiltrating the bone. The surgical margins were however in sano. Adjuvant radiotherapy to 60Gy dose of the surgical area was indicated after surgery. The consequences of surgery and radiotherapy were simple. However local changes to show a progressive refinement of the nasal skin due to irradiation leading to a small titanium plate exposure revision surgery with coverage by a glabellar flap associated with a time of lipomodeling unexposed areas have improved and trophism of soft tissue. Two further lipomodeling sessions have yielded a good quality and stable skin. From an oncological point of view, no recurrence was detected with a decline of 10years. Aesthetic and functional point of view the results were highly satisfactory. Oncologic resections subtotal nasal pyramid are complex, we will see the benefits and disadvantages of the different techniques used in the different stages. This case report illustrates the difficulties of reconstruction after wide excision of mucosal lesions root of the nose carrying the mucous plan and nasal bones. It stresses the importance of bone reconstruction titanium plate and innovative element, the efficiency of fat transfer to restore the quality and trophicity soft tissue. Fat transfer in addition to reconstructions by titanium plates and splints may thus expand the indications of these types of techniques in complex facial and cranial reconstructions.

Nasal dorsal glabellar flap in the treatment of nasal tip defects

Nasal dorsal glabellar flap in the treatment of nasal tip defects

Aesthetic Unit-Based Reconstruction of Periorbital Defects.

The aim of this study was to perform a retrospective analysis of patients who underwent periorbital area reconstructions, determine their sociodemographic characteristics, analyze the effects of defect etiologies and locations classified according to periorbital subunits on our reconstruction options, and to present our treatment outcomes and clinical experience. A retrospective chart review of 23 patients operated in our department between January 2010 and March 2013 and underwent periorbital area reconstructions, was performed. In addition to the demographic characteristics of the patients; defect etiologies, locations according to Spinelli aesthetic subunits, and the degrees of involvement were determined. Analysis of the reconstructive methods showed that primary closure with lateral cantholysis was performed in 1 patient with a defect involving less than 50% of zone 1 along with a partial defect involving less than 50% of zone 2. In another patient with a full-thickness defect involving 75% of zone 1, reconstruction was made with a temporally based monopedicle forehead transposition (Fricke) flap prepared from the lower eyelid, and a conchal cartilage graft. In 2 other patients with partial defects involving more than 50% of zone 2; reconstruction was made with full-thickness skin grafts taken from the retroauricular area. Four patients had full-thickness defects that involved 50% to 75% of zone 2; 3 of them were reconstructed with a Tenzel lateral semicircular rotation flap and 1 with a Tripier flap. In 3 patients who had full-thickness defects involving 75% of zone 2; reconstruction was made with a paramedian forehead flap and conchal cartilage graft. In 3 patients with full-thickness defects involving more than 75% of zone 2, a Mustarde cheek rotation flap was used for reconstruction. Six patients had defects in zone 3, 3 of them were reconstructed with a glabellar flap, 2 with a paramedian forehead flap, and 1 with a bilobed flap. One patient with a defect that involved 50% of zone 4 was reconstructed with a McGregor flap. Construction of a reconstructive algorithm by separation of the eyelid into aesthetic units and use of local healthy tissues provide functionally and aesthetically acceptable results.

Monophasic Synovial Sarcoma of the Lower Eyelid: Rare Tumor involving Rare Site

ABSTRACT Aim Synovial sarcoma of eyelid is extremely rare. We are reporting a case of massive synovial sarcoma of lower eyelid extending to soft tissues over the anterior wall of maxilla. Case report A 58-year-old male patient presented with a large mass involving the left lower eyelid and extending over the soft tissues of the anterior wall of the maxilla since 15 years. Clinical examination showed a firm soft tissue mass measuring 16 × 8 × 6 cm involving the left lower eyelid and extending to soft tissues over the maxilla. The mass showed ulceration and was bleeding on touch. Computed tomography scan showed an exophytic lobulated heterogeneously enhancing mass lesion with intense enhancing capsule measuring 14 × 9.3 × 8.4 cm with few internal areas of necrosis arising from left preseptal region. The lesion was causing erosion at the medial wall and floor of left orbit. It was clinically diagnosed as hemangiopericytoma. The patient was taken up for surgery and wide excision of the tumor and medial maxillectomy was done. The defect was reconstructed with a glabellar flap. How to cite this article Mohiyuddin A, Sagayaraj A, Harshita TR, Suresh TN. Monophasic Synovial Sarcoma of the Lower Eyelid: Rare Tumor involving Rare Site. Int J Head Neck Surg 2015;6(4):190-192.

Nasal Reconstruction: A Simplified Approach Based on 419 Operated Cases.

The purpose of this review is to examine a single surgeon's 10-year experience with nose defects and offer a simplified approach for nasal reconstruction to close most nasal defects following Mohs micrographic surgery (MMS). A retrospective chart review was performed on patients undergoing repair of MMS defects of the nose over a 10-year period. Data collected included patients' age and sex, anatomic location of the defect, type of reconstruction, and number of operations required. A total of 419 patients were included in this study. The most common location for nasal reconstruction was the nasal dorsum and sidewalls (66.35 %). Complications mainly related to reconstruction of defects of the tip ± ala (n = 31), followed by the ala (n = 15) and the dorsum and sidewalls (n = 13). Bulkiness of the flap used (n = 32) and hypertrophic scar (n = 13) were the most common complications. The bilobed flap was the most commonly used flap (n = 145), followed by nasolabial flap (n = 69), FTSGs (n = 63), forehead flap (n = 62), and dorsal glabellar flap (n = 44). In this article, a simplified approach for nasal defects reconstruction is presented, which is based on commonly performed local flaps and skin grafting. This algorithm can be useful for the novice plastic surgeons in planning a reconstructive strategy that will be efficient, easy to perform, and produces an acceptable esthetic and functional outcome.

English

CASE SUMMARY: A 45year old lady presented to outpatient clinic with pain & swelling in the medial canthal area and watering from Left eye simulating acute dacryocystitis. Patient was treated for the same but with no response. After 4-5visits, she developed non healing ulcer over the same area. The patient was otherwise healthy, with no history of excessive sun exposure or any predisposing factors for skin cancer. Examination revealing 2cm×2cm ulcer with slightly elevated pigmented margin (fig: 1) involving the puncta posed a real diagnostic dilemma. The lesion was subjected for excisional biopsy with 3mm clear margin under local anaesthesia. As the punta were also involved, a medial 25% of full thickness lid was excised along with main lesion (Fig: 2). Concomitant dacryocystectomy was carried out. Canthal reconstruction was done followed by direct approximation of lid defects to newly formed canthus. A myo cutaneous glabellar flap was transposed to the defect area with inverted V-Y closure (fig: 3). Histopathological examination under low power showed solid islands of tumor cells with peripheral palisading; there is also a clefting artifact in between the stroma and epithelium. High power shows pigments within solid highland basal cells and in macrophages suggestive of pigmented basal cell carcinoma. 1month Postoperative period was uneventful, with acceptable cosmetic appearance. Unusual presentation of pigmented chronic ulcer with watering in a middle aged lady diverted our attention towards non-malignant pathology resulting in erroneous initial diagnosis & treatment.

Reconstruction of Complex Nasal Dorsal and Sidewall Defects

To demonstrate that by the extended use of cheek advancement flaps, the need to maintain the nasal dorsal side unit is obviated. Retrospective case series. Tertiary care clinic and hospital. Twelve patients aged 48 to 88 years who underwent Mohs micrographic surgery for nasal skin neoplasms, presenting with dorsal sidewall and nasal dorsal cutaneous defects. All patients underwent nasal reconstruction with adjacent tissue cheek advancement flaps with or without contralateral nasal dorsal and sidewall advancement flaps. Avoidance of ipsilateral nasal sidewall scars to allow a natural-appearing transition between the cheek and nose and avoidance of forehead flap morbidity. Results Satisfactory results were achieved in all but 1 patient who had partial flap necrosis. To maintain the nasal dorsal sidewall unit, superior, central dorsal, and nasal sidewall defects have traditionally been reconstructed using a variety of techniques, including skin grafts and regional flaps, such as glabellar flaps and frontal flaps. We demonstrate that creation of the nasal dorsal sidewall unit is often not necessary, and excellent results can be achieved through the expanded use of cheek advancement flaps.

Levator anguli oris muscle based flaps for nasal reconstruction following resection of nasal skin tumours

Backgroundsurgical excision remains the best tool for management of skin tumors affecting nasal skin, however many surgical techniques have been used for reconstruction of the nasal defects caused by excisional surgery. The aim of this work is the evaluation of the feasibility and outcome of levator anguli oris muscle based flaps.MethodsNinety patients of malignant nasal skin tumours were included in this study. Age was ranged from four to 78 years. For small unilateral defects affecting only one side ala nasi, levator anguli oris myocautaneous (LAOMC) flap was used in 45 patients. For unilateral compound loss of skin and mucus membrane, levator anguli oris myocautaneous mucosal (LAOMCM) flap was used in 23 patients. Very large defects; bilateral either LAOMC or LAOMCM flaps combined with forehead glabellar flaps were used to reconstruct the defect in 22 patients.ResultsWound dehiscence was the commonest complication. Minor complications, in the form of haematoma and minor flap loss were managed conservatively. Partial flap loss was encountered in 6 patients with relatively larger tumours or diabetic co-morbidity, three of whom were required operative re-intervention in the form of debridement and flap refashioning, while total flap loss was not occurred at all.ConclusionsImmediate nasal reconstruction for nasal skin and mucosal tumours with levator anguli oris muscle based flaps (LAOMC, LAOMCM) is feasible and spares the patient the psychic trauma due to organ loss.

Reconstruction of medial canthal skin defects with local flaps： 15 case report

Objective To reconstruct skin defects with local flaps after resection of tumors. Methods From October 2006 to December 2009, medial canthal defects in 15 patients were repaired with local flaps in the hospital. The size of the defects varied from 1 cm × 1 cm to 1.8 cm × 2.0 cm. According to the size and location of the defects, different local flaps such as glabellar flaps ,rotation flaps, advancement flaps, nasolabial flaps and combination of these local flaps were selected and designed to repair the skin defects. Results Of the 15 patients, 12 received the reconstruction of skin defects with single flap, the other 3 with two flaps; totally,18 local flaps were designed and applied. All the flaps survived with primary healing postoperatively. A followup in 11 patients for 6 to 12 months showed that the color and texture of flaps were similar to those of surrounding tissues and incision line scar was inconspicuous. Medial canthal contours were restored without distortion of surrounding structures. Satisfactory function and aesthetic outcomes were achieved. Conclusions In the repair of inner canthus skin defects, to maintain and restore the ＂cosmetic unit＂ integrity of inner canthus by using suitable local flaps would lead to a satisfying restoration of function and appearance. Key words: Skin neoplasms; Reconstructive surgical procedures; Surgical flaps