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Reconstruction of Nasal Skin Cancer Defects with Local Flaps

DOI: 10.1155/2011/181093

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Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose. 1. Introduction The most common site of facial skin cancer is the nose (25.5%), because of its cumulative exposure to sunlight [1–3]. When dealing with primary non-melanoma nasal skin cancers, the most important goal is to obtain a tumor-free patient. Several studies have outlined the surgical parameters necessary for the excision of primary nonmelanoma skin cancers [4–6]. Well-defined primary basal cell carcinomas (BCCs) less than 2?cm in diameter should be excised with 4.0-mm margins to obtain a 95% cure rate [5]. Primary squamous cell carcinomas (SCCs) require 4.0-mm margins for low-risk tumors and 6.0?mm margins for high-risk tumors (≥2.0?cm; >II histological grade; nose, lip, scalp, ears, eyelids; invasion into the subcutaneous tissue) to obtain a 95% cure rate [4, 6]. For these tumors, Mohs micrographic surgery offers improved cure rates, as it is a technique that allows for complete microscopic control of tumor removal in addition to superior tissue preservation. The Mohs technique described in 1941 is based on the concept of excising skin cancer layer by layer and examining horizontally cut specimen sections to view the entire surgical margin. The disadvantages of the Mohs technique are that it is labor intensive, time consuming, and quite dependent on the skills of not only the Mohs surgeon/pathologist but also the histotechnician who prepares the specimens. In addition, high cost has been a criticism of Mohs surgery in the literature [7].

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