Face and Nose Reconstruction With Forehead Flap, Skin Cancer, Kevin Kavanagh
Facial and Nose Reconstruction With Forehead Flap, Skin Cancer, Kevin Kavanagh
  
Nasal Reconstruction Forehead Flap in a Patient
With Morfeaform Basal Cell Carcinoma ( Skin Cancer )
 

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A patient with a large morpheaform basal cell carcinoma of the nose was removed with Mohs surgery.   A very large defect was created.

Morpheaform basal cell carcinoma tracks under the skin and large defects are often required to remove seemingly small lesions.

The skin over the nasal tip and nasal-frontal angle was mobilized to decrease the height of the defect.

The patient's forehead skin was tight and a a 2 cm width forehead flap was outlined.

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The flap is elevated over the periosteum and sewn into the donor defect.  Because of the large width of the defect, the flap was placed horizontally. The flap appeared pale and a crease was present which reduced blood flow.  A superior stitch was removed which improved the flaps color.

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The scalp is undermined to aid in closure of the donor site.

The forehead was closed under a fair amount of pressure.  In some patients a flap width of 2.5 cm could be used.

However, in this patient this might have required closure of the donor site using excess tension.  Excessive tension is a common cause of skin necrosis.  It is very important to close the forehead fascia to take the tension off of the skin closure. 
 

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 Final closure.  Surgical is used to plug the diamond shaped defect just above the flap's origin.

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The patient is seen the next day to check both the flap's viability and the viability of the forehead skin.  If the tissues appear to have poor blood flow, sutures can be removed.     Four days post-op.

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Eight days post-op.  32 days post-op, patient is seen for pre-op visit for second stage of surgery.  Note the multiple sub-cu stitch reactions to the chromic forehead stitches.

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The flap's pedicle is divided and a portion is resected.  The recipient site is repaired. 
 

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The donor site is repaired. 

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Eight days post-op second stage.  Three weeks post-op.

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5 Months post-op.  10 Months post-op.

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   1 year post-op.

Up Forehead Flap Forehead Flap - Flash Abbe Estlander Flap Abbe Estlander Flash Abbe Estlander Flap Abbe Estlander Flap Rotation Advancement Rotation Advancement Rhomboid Flap Rhomboid Flap Rhomboid Flap Bilobed Flap Bilobed Flap - Flash Nasolabial Flap Nasal Labial Flap Nasolabial Flap Nasolabial Flap Ear Reconstruction Nasolabial Flap Ear Reconstruction Ear Reconstct. Flash Flap Necrosis

       
  


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