Case 3 Excision and Fullthickness Skin Graft on the Nose

This patient presented with Hutchinson's melanotic freckle (lentigo maligna) on the dorsum of the nose. The desired extent of excision is marked out with a skin marking pen and its dimensions are measured. The ideal donor site is the skin of the supraclavicu-lar region for a defect of this size.

The postoperative appearance of the skin graft in this patient immediately after surgery is shown in Figure 4-6A and 6 months postoperatively in Figure 4-6B. Since sensations on this skin are absent, the

Nasal Skin Graft

Figure 4-5. A Incisions outlined for excision of a recurrent basal cell carcinoma of the frontal scalp. Band C, A scalp flap is elevated rotated and advanced into the surgical defect. D, Postoperative appearance of the patient 7 months following surgery.

Figure 4-6. A Immediate postoperative appearance of a full-thickness skin graft on the dorsum of the nose. B, The same patient 6 months later.

Case 4. Glabellar Flap

Figure 4-6. A Immediate postoperative appearance of a full-thickness skin graft on the dorsum of the nose. B, The same patient 6 months later.

patient must avoid trauma to prevent ulceration and infection. The esthetic result with a full-thickness skin graft is excellent on the lateral aspect of the nose with no specific donor site deformity.

Case 4. Glabellar Flap

This flap is best suited for reconstruction of surgical defects at either the bridge or the upper half of the nose. It is an axial flap, which derives its blood supply mainly from the supratrochlear artery and also from the dorsal nasal branches. The flap can also be used for complex defects of the nasal dorsum with a split-thickness skin graft on its undersurface.

The patient shown here has a basal cell carcinoma involving the skin of the bridge of the nose (Figure 4-7A). The skin is freely mobile over the underlying periosteum. The lesion is excised and flap rotated into place for reconstruction (Figure 4—7B). The skin flap has set well in place with well balanced eye-

Figure 4-7. A The lesion is a basal cell carcinoma of the skin of the nose. B The defect of surgical excision and outline of the glabellar flap. C, The flap is inset and the donor defect is closed primarily.

brows on both sides and satisfactory coverage of the skin and soft-tissue defect at the bridge of the nose. Closure of the donor site leaves an esthetically acceptable midline vertical scar (Figure 4-7C).

A modification of this procedure is an island glabellar flap where the flap is tunneled under an intact bridge of skin at the glabella, keeping its blood supply intact on the vascular pedicle containing the supratrochlear artery and vein. However, elevation of an island flap in this fashion is risky and has very limited application.

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