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This is a nasal labial flap which was used to close a nasal tip defect in a 90 yr old patient.  A single stage surgery was requested.  The patient was started on Pentoxifylline immediately after the operation and told not to use tobacco products.

The flap was 4.5 by 1.5 cm and had a length to base ratio of approximately
3 : 1 .  The distal 0.75 cm of the flap was lost.  the surviving portion of the flap had a length to base ration of  2.5 : 1 . 

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4 month post-operative result

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Nose Defect After Excision of Lesion

The flap had a length to base ratio of approximately 1.5 : 1  Despite this the lower aspect of the flap had mild cyanosis.  The patient was started on Pentoxifylline and told not to use tobacco products.

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At 5 days the lower end of the flap was becoming necrotic.  Sutures were released and the flap regained some color.

At 7 days the necrotic area demarcated.  The escar was not disturbed since fibrous tissue below the skin may still be viable

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5 mo Post Op Result 

5 mo Post Op Result  

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8 mo Post Op Result

The final result after healing by secondary intension is shown here.

8 mo Post Op Result

The final result after healing by secondary intension is shown here.