Restoration of Large Skin Defect on Nose Dorsum using Nasalis Island Pedicle Flap with Bilevel Undermining / 대한피부과학회지

Reconstruction of defects on the lower third of the nose is always a challenge, as dissection of tissues in this area is not simple due to both a lack of elasticity and the structural complexity of the mid-facial area. When the defect size is less than 1.5 cm on the nose, primary closure or a bilobed flap is widely-used, while a skin graft is required for reconstruction of larger defects. Here we present two cases of a nasalis myocutaneous island pedicle flap with bilevel undermining with a relatively large nasal dorsum defect (>2 cm). The nasalis myocutaneous island pedicle flap with bilevel undermining was performed in order to maximize the movement of skin flaps and minimize the secondary movement of flaps after surgery. The nasal tip showed a slight upward movement immediately after surgery that subsequently moved down to a normal level. This technique can be utilized for reconstruction of the lower part of the nose for defects 2 cm or larger in size by maximizing the movement of the flap within the nasal structure. A major advantage is a higher flap survival rate due to proper arterial supply and the procedure results in relatively reduced secondary motion of the flap after the surgery.

Nasalis Island Pedicle Flap for Reconstruction of the Nasal Defect / 대한피부과학회지

BACKGROUND: Reconstruction of surgical defects of the nose is often challenging. There are many repair options for a nasal defect, including second-intention healing, primary closure, a skin graft and a skin flap. Among these, the nasalis island pedicle flap is a random pattern advancement flap that has satisfactory vascular supplies from the underlying muscular structure. OBJECTIVE: We wanted to describe the surgical technique of creating a nasalis island pedicle flap and to report on our experience with the postoperative cosmetic outcome. METHODS: Fourteen patients diagnosed with non-malignant melanoma skin cancer on the nose were treated with Mohs micrographic surgery (MMS). The surgical defects were reconstructed with a nasalis island pedicle flap. The size of the tumor and the postoperative surgical defects, the local complications and the cosmetic outcomes were assessed. RESULTS: The size of the primary defects ranged from 0.8 to 2.3 cm at the greatest dimension (with a mean of 1.51 cm). Five cases were located on the nasal ala, three on the nasal dorsum, two on the nasal root, two on the nasal side wall and two on the nasal tip. During the follow-up period, there was no significant postoperative bleeding, necrosis and infection. There was no tumor recurrence and most of the patients showed minimal discernable scarring with satisfactory aesthetic outcomes. CONCLUSION: A nasalis island pedicle flap provided aesthetically pleasing results, and it could be an useful method to reconstruct surgical defects in the nose after MMS.

Postauricular Island Pedicle Flap ("Flip-Flop" Flap) for Reconstruction of the External Ear Defect / 대한피부과학회지

About six percent of head and neck cancers occur on the external ears. Excision of the cancer can cause changes of morphology and poor cosmesis. Reconstruction of ear defects presents a unique and notable challenge to the dermatologic surgeons. This is due to the complex architecture of the external ear which is difficult to duplicate surgically. Several methods are available for reconstruction of defects to the external ear. However, the diversity of external ear shapes shows how difficult it is to achieve a certain solution to this problem. Postauricular island pedicle flap was initially reported as a technique for reconstruction of small defects of the concha after excision, and has since been used successfully in the repair of more extensive defects involving not only the concha, but also the antihelix and external auditory meatus. We report two cases of auricular squamous cell carcinoma in which the skin defect is reconstructed by a postauricular island pedicle flap ("flip-flop" flap).

Reconstruction of Defects on the Lower Part of the Nose using Nasalis Island Pedicle Flap / 대한피부과학회지

Reconstruction of surgical defects of the nose, particularly the lower one third, is often challenging. The skin of this area is less mobile and fixed on lower structures without a subcutaneous fatty layer. Thus, dissection of tissues is rather difficult and more bleeding can occur during dissection. Furthermore, flap surgery will fail if the flap extends too far. Local flap surgery is one of the more useful techniques that maintains the function and aesthetics of a normal nose. Among these, the nasalis muscle is relatively easy and provides better outcomes. More importantly, vascular supplies from the underlying muscular structure provide greater viability. Additional movement can be achieved by either dissecting under the transverse nasalis or by dividing the transverse nasalis beyond the midline. We report 5 cases of nasalis island pedicle flaps using nasalis muscles. The final results were relatively satisfactory for both functional and cosmetic aspects.

A Case of Reconstruction of Upper Cheek with Subcutaneous Island Pedicle Flap / 대한피부과학회지

Subcutaneous island pedicle flap is a kind of advancement flap and provides a blood supply by the vascular pedicle. It guarantees a small wound, less tension, but sometimes leaves cosmetic problems like a triangular or trap-door scar. Generally, reconstruction of the upper cheek with subcutaneous island flap is not a good choice. A rotation flap or simple elliptical excision is relatively easy and gives a better cosmetic result. However, our patient had a long history of taking blood thinning medication and the location of cancer was close to the eyes and nose. Therefore, we chose subcutaneous island pedicle flap and got relatively good cosmetic results without severe bleeding or distortion of the eyes and nose.

Local Flaps for Reconstruction of Nasal Defects / 대한피부과학회지

BACKGROUND: The skin over the nose is not relatively less mobile for primary closure of nasal defects. In addition to skin grafts and secondary intention healing, there are various local flap techniques available for the reconstruction of nasal defects. OBJECTIVE: The aim of this study was to assess the effectiveness and the cosmetic consequences of various local flap techniques in reconstructing nasal defects. METHODS: Between December 2002 and April 2004, 18 patients were treated with a local flap technique for the reconstruction of a nasal skin defect following Mohs micrographic surgery. The post-operative result of each case was rated with serial clinical photographs and medical records by two independent physicians. RESULTS: The nasal skin defects were reconstructed with various local flaps, such as the nasolabial interpolation flap, bilobed flap, glabellar flap, median forehead flap, and subcutaneous island pedicle flap. The cosmetic and functional results of the nasal reconstructions were judged to be generally satisfactory, excluding a trapdoor deformity in one patient, and eyebrow distortion and cancer recurrence in another patient. The cosmetic results of the cases reconstructed with a subcutaneous island pedicle flap were favorable in color and texture of the flaps, and incision scar formation, compared to the other techniques used. CONCLUSION: There are various local flap techniques which can be used in the reconstruction of nasal defects, and each of them has its own merits and drawbacks. The reconstructive plan should be customized to the patient considering not only the size, depth and location of the defect but also the medical history of the patient, the patients expectations, and the surgeons experience. Reconstruction with a subcutaneous island pedicle flap has been found to be one of the most effective methods, and allows the surgeon to spend a relatively short time in reconstructing defects of the upper and lower part of the nose. Furthermore, it has many advantages over the skin graft and other local flap techniques, especially with the aesthetic result.

Reconstruction of Nasal Alar Defect with Transposition of the Island Pedicle Flap / 대한피부과학회지

Transposition of the island pedicle flap is a versatile method of mobilizing tissue from a relatively distant reservoir and moving it across intervening tissue. Advantages are the similar color and texture to those of the affected area, the minimal donor scar, the increased viability with local blood supply, and the potential to camouflage scars into natural skin lines or cosmetic units. In a 73-year-old woman, the lesion of a basal cell carcinoma on her left nasal ala was removed by Mohs micrographic surgery and the resultant defect was reconstructed by transposition of the island pedicle flap. In our case, there were no significant complications and the final result was satisfactory in both functional and cosmetic aspects. Through our experience, we can confirm that transposition of the island pedicle flap is another alternative for the reconstruction of nasal alar defects.

Reconstruction of Facial Defects with Subcutaneous Island Pedicle Flap / 대한피부과학회지

Subcutaneous island pedicle flap is based on the basic principle of V-Y advancement and closure. This advancement flap involves the isolation of a segment of skin as an island disconnected from the peripheral epidermal-dermal attachment. Subcutaneous island pedicle flap offers several distinct advantages over various transposition flap and skin graft. Moreover its design and execution are straightforward, being a conceptual extension of the elliptical excision technique. Four cases of malignant tumors on the face were removed by Mohs surgery, followed by reconstruction of defects with subcutaneous island pedicle flap. In our cases, there were no significant complications and the results were cosmetically acceptable. Subcutaneous island pedicle flap is a simple and satisfactory alternative for the reconstruction of medium-sized defects in the face.