The Nasal Tip Rotation Flap for Reconstruction of the Lateral Nasal Tip, Anterior Ala, and Soft Triangle: The Authors' Experience With 55 Patients.

BACKGROUND: Defects of the lateral nasal tip, anterior ala, and soft triangle subunits lack reconstructive options that are consistently satisfactory. For such defects, the novel anterior-based nasal tip rotation flap provides functional and aesthetic results in a single operative session. OBJECTIVE: To describe the authors' experience with the nasal tip rotation flap, including patient selection and design modifications to enhance aesthetic success. METHODS: An IRB-approved retrospective database review of nasal tip rotation flap repairs was performed at the Medical University of South Carolina and Stanford University Medical Center. The design and surgical technique of this flap are described and illustrated, emphasizing factors such as nasal shape and defect location in modifying flap design. RESULTS: The nasal tip rotation is a single-stage, local flap that provides optimal tissue match with recapitulation of the native topography of the nasal tip and incision lines that are well hidden at the junction of cosmetic subunits. The mechanics of the flap distribute closure tension widely across the alar rim without focal notching or airway compromise. CONCLUSION: The nasal tip rotation flap is a reliable, cosmetically elegant repair that fills a gap in the reconstructive options for anterior ala and soft triangle defects on the nose.

Applications of Burow's Grafts in the Reconstruction of Mohs Micrographic Surgery Defects.

BACKGROUND: Surgical defects in anatomically challenging locations, such as near free margins or crossing cosmetic subunits, may present reconstructive challenges to the dermatologic surgeon. For selected defects, Burow's grafts may produce functional and aesthetic results in a single operative session. OBJECTIVE: To describe the applications of the Burow's graft technique for the repair of defects after Mohs micrographic surgery. METHODS: An institutional review board-approved retrospective database review of surgical defects repaired with Burow's grafting after Mohs micrographic surgery at the Medical University of South Carolina was performed. The general technique of Burow's grafting is described, emphasizing proper graft sizing and direction of tension vectors. Varying anatomic locations and defect types are presented, with site-specific considerations and operative photographs. RESULTS: Burow's grafting provides ideal color and textural match, preserves subunit boundaries, results in a compact single-site wound, and may avoid complications of alternate repair choices. The tension vectors produced in closing the graft's harvest site may be designed to prevent distortion of free margins. Burow's grafting may be combined with hinge flaps to repair deep or avascular defects. CONCLUSION: Burow's grafts are reproducible, aesthetic, and useful reconstructive choices for a variety of surgical wounds.