The median forehead flap reviewed: a histologic study on vascular anatomy.

Local skin flaps can be divided into two types: random flaps and axial flaps. An axial flap is defined as a flap containing a named artery in its pedicle. For the paramedian forehead flap (PMFF) a lot of surgeons insist on the point that the pedicle must contain the supratrochlear artery. To demonstrate that median forehead flaps (MFF) need not contain a named artery, we selected first 8 patients with a PMFF and further 12 patients who had undergone reconstructive surgery using a MFF. After division, we analysed the pedicle of the flap histologically and measured the diameter of the arteries or arterioles and compared them to anatomical descriptions of the frontal arteries. In none of the 12 cases could we find a functional artery of approximately 1 mm in diameter that could correspond to the supratrochlear artery. The MFF is an axial flap but not in accordance with the current definition of this term. In contrast to published literature, we show that only in a part of cases a named artery was present in the pedicle. Despite this fact, the MFF is a secure flap for full thickness defect repair on the nose.

The medial based bi- or trilobed flap for repair of distal alar defects.

BACKGROUND: Reconstruction of defects of the lateral nasal ala might be challenging. Reconstruction with a bi- or trilobed flap is common. The laterally based bi- or trilobed flap for defects of the distal ala or lateral tip of the nose produces mostly tissue protrusion in the nasal groove which is aesthetically unpleasant. Why not use more the medially based bi- or trilobed flap? OBJECTIVE: To describe the utility of bilobed and trilobed flaps for alar defects insisting on the design of medially based flaps. METHODS: To show the technique and practical application for this kind of reconstruction. RESULTS: The bi- and trilobed flaps are useful for defect repair between the lateral nasal tip and the distal ala. We observed that in most cases the flap based medially respects anatomical subunits better than the laterally based flap for medium-sized defects of the distal ala of the nose. CONCLUSION: I suggest that the bi- and trilobed flaps for repair of the lateral tip/distal ala should more often be medially based. This flap has a specific indication and precise advantage compared to other reconstructions, especially to the laterally based multilobed flaps in this specific indication.

Birhombic flap, a modified bilobed flap, for repair of nasal defect.

BACKGROUND: Reconstruction of longitudinal defects of the lateral nasal alar might be challenging. Reconstruction with a bilobed flap is common for round defects normally the bilobed flap is less suited for longitudinal defects. OBJECTIVE: We describe a birhombic flap for longitudinal defect. METHODS: Demonstration of the technique and practical application for this kind of reconstruction. RESULTS: The bilobed flap is a very useful flap for lateral nasal tip or distal alar reconstruction. We show that a small modification of the flap allows to cover also longitudinal defects on the lateral tip of the nose. As the first lobe movement corresponds more to the rhomboid transposition flap, we prefer to call it birhombic flap. CONCLUSION: The birhombic flap has its place in reconstructive surgery. This flap has a specific indication and precise advantages to other repairs in particular to the bilobed flap.

Island pedicle flaps for medial canthus repair.

BACKGROUND: The medial canthus is a frequent site for skin cancer and reconstruction after Mohs surgery can prove to be challenging. In the literature various reconstruction methods are recommended for these cases. Flap reconstructions are mostly transposition flaps from the glabella, skin with different properties from that in the canthal region, hence mostly requiring correction in a second stage. OBJECTIVES: To ascertain the utility of a different reconstruction method, applying island pedicle flaps for medial canthal lesions and obviating the necessity for second-stage corrections. METHODS: A review was undertaken of the medical records and photographs of patients who had a pedicle island flap reconstruction for medial canthal defects after Mohs surgery. There were four different possibilities: a pedicle island flap from the cheek, the back of the nose or the glabella or a combination of these flaps. RESULTS: Sixteen patients were reconstructed by pedicle island flaps for defects of the medial canthal area. A follow-up for all patients after 1 year indicated that all patients showed good to excellent results. No cases of web deformation and ectropion were found. CONCLUSIONS: This flap is not mentioned in textbooks in reference to the reconstruction of canthal lesions and its value for this particular location is probably underestimated.

The transposition advancement flap for repair of postsurgical defects on the upper lip.

BACKGROUND: Skin cancer of the lip is frequent, and reconstruction after Mohs surgery might be challenging mostly when the postsurgical defect has a size of more than 1 cm(2) and is situated adjacent to the philtrum. OBJECTIVE: We present a combination of a transposition and advancement flap for the reconstruction of postsurgical defects of the upper lip. METHODS: Demonstration of the technique and practical application for this kind of reconstruction. RESULTS: The transposition advancement flap (TAF) presents excellent results for medium defects of the upper lip medially adjacent to the philtrum. CONCLUSION: The TAF can be used in the reconstruction of the major part of postsurgical lip defects in the medial two fifths of the upper lip without any risk of lip distortion. As this flap is easy to perform, it is an important tool in the armamentarium of the dermatologic surgeon.

Recurrence of basosquamous carcinoma after Mohs micrographic surgery.

BACKGROUND: The recurrence rate of basal cell carcinoma (BCC) after Mohs micrographic surgery (MMS) is well documented. Only little is published concerning the recurrence rate in relation to the different histologic subgroups. OBJECTIVE: To analyze the recurrence rate of the different histologic groups and subgroups after MMS. SUBJECTS AND METHODS: We investigated 1,000 cases of epidermal tumors in a private center of MMS including BCC, squamous cell carcinoma and basosquamous carcinoma (BSC) treated by MMS from 1998 to 2007 in a retrospective study. The cases where analyzed regarding the histologic groups and subgroups. The mean follow-up time was 59.55 months. RESULTS: The recurrence rate of epidermal tumors in this study was about 2.5% and comparable to that in the literature. Interestingly we observed a relatively high incidence and recurrence rate of BSC compared to other studies. CONCLUSION: BSC seems to be highly aggressive and subject to recurrence even after MMS. The classical approach to stop further excision once the excision is total should be reevaluated.

The interposed nasalis myocutaneous island flap for lesions of the ala and lateral tip of the nose.

BACKGROUND: Skin cancer of the ala of the nose is observed frequently. The local defects after Mohs surgery in this localization are difficult to repair by a 1-step procedure. OBJECTIVE: The purpose of this paper is to present a new flap for lesions of the nasal ala. METHODS: The design and positioning of the flap is demonstrated with photographs. RESULTS: The interposed nasalis myocutaneous island flap is a new flap with a good viability and clinical results. CONCLUSION: The interposed nasalis myocutaneous island flap is a reliable flap for the reconstruction of ala defects and defects of the lateral tip of the nose.

Rotation flap reconstruction for nasal tip defect after mohs surgery.

BACKGROUND: Skin cancer of the nasal tip is frequent, and reconstruction after Mohs surgery might be challenging. The rotation flap is a very commonly used flap for reconstructions on the vertex and the extremities but rarely on the nose. In textbooks rotation flaps in nose reconstruction are rarely mentioned. OBJECTIVE: We present a rotation flap from the caudal tip and the columella of the nose for defects of the lateral tip of the nose. METHODS: With graphics and photographs of case studies we explain the mechanism of placement and movement of the flap. RESULTS: The rotation flap is useful for reconstructions of medium-size defects of the distal lateral nose tip. CONCLUSION: The rotation flap can be used in the reconstruction of laterally placed nasal tip defects. As this flap is not mentioned in textbooks for nasal tip reconstruction, its value for this localization is probably underestimated.

[Mohs micrographic surgery: concept, technic and indications]. / La chirurgie micrographique selon Mohs: concept, technique et indications.

Mohs Micrographic Surgery is a technic to treat severe cutaneous carcinoma. By performing a microscopic and topographic analysis of the whole tissue excised, both a reduction of the surgical margin and margins in normal tissue is obtained. The major indications of micrographic surgery are recurrent basalcell carcinoma after surgery or radiotherapy, not fully excised or localized on the nose and the mediofacial region, some spinouscell carcinoma and dermatofibrosarcoma protuberans.

[Autologous fat transplantation in dermatology]. / Technique de comblement par tissu adipeux autologue en dermatologie.

The technique of autologous fat transplantation (lipofilling) allows to correct congenital or acquired abnormalities of the cutaneous relief. Autologous fat lobules aspired in one site are transplanted by injection in the zone to treat. This technique is performed ambulatory under local anesthesia and it is possible to perform long term correction of dermal or hypodermal atrophy of one to few centimetres.

Refinement of the island pedicle flap: parallel placed release incisions to increase translation movement.

BACKGROUND: The island pedicle flap is a widely used flap for reconstructions in the face and on the extremities. The movement of the flap is limited because of the traditionally inferiorly based pedicle that allowed only rotation or advancement. OBJECTIVE: The purpose was to enhance translation movement by modifying the pedicle. METHODS: The modification of the flap is demonstrated with graphics and documented with photographs. RESULTS: Parallel release incisions did not interfere with the viability of the island pedicle flap. CONCLUSION: Parallel incisions enhance largely the translation vector of the island pedicle flap and the myocutaneous island flap without interfering with the viability of the flap.

Diagnostic and surgical accuracy and economic aspects of dermatological surgery - a pilot study.

BACKGROUND: Good skin care for oncological dermatological patients includes efficacious excision to achieve tumour control and economically reasonable costs. This field concerns dermatologists as much as other surgical specialities. METHODS: Of 944 excisions and biopsies, we studied 114 epidermal carcinomas excised by plastic surgeons and dermatologists. This allowed us to compare the accuracy concerning oncological surgical aspects as well as the extrapolated costs produced by these two specialities. RESULTS: Dermatologists are significantly more accurate concerning total excision of epidermal tumours compared to plastic surgeons. CONCLUSION: From an economic point of view, plastic surgeons are increasingly more expensive than dermatologists. Most expenses are due to the use of a hospital operating room.