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Nasal Reconstruction Forehead
Flap in a Patient
With
Morfeaform Basal Cell Carcinoma ( Skin Cancer )
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1.
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2 |
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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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5. |
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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.
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Four days post-op. |
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10. |
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11. |
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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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12. |
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13. |
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The flap's pedicle is divided and a portion is resected. |
The recipient site is repaired. |
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14. |
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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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18. |
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5 Months post-op. |
10 Months post-op. |
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