Free Margin Distortion With Fusiform Closures: The Apical Angle Relationship

Intrasubunit V-Y Muscle Sling Myocutaneous Island Advancement Flap for Small Defects Isolated to the Nasal Ala

BACKGROUND

The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae.

OBJECTIVE

To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects.

MATERIALS AND METHODS

A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS).

RESULTS

A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes.

CONCLUSION

The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala.

Optimizing Design and Execution of Linear Reconstructions on the Face

BACKGROUND

Linear closure (LC) is the most common reconstructive design for cutaneous defects. Successful performance of a LC is dependent on both appropriate surgical planning and technical execution.

OBJECTIVE

To review the design and execution of LCs on the face.

MATERIALS AND METHODS

A systematic evaluation of LCs is provided to guide a logical approach for the repair of cutaneous facial defects.

RESULTS

Reproducibly excellent aesthetic and functional results may be achieved with strategies that reduce incisional tension, preserve free margin position, and restore skin contour. Cosmetic unit borders and relaxed skin tension lines may be used to further camouflage facial scars. A comprehensive knowledge of facial anatomy, biomechanical properties of the skin, and incisional tension vectors facilitates correct preoperative planning and intraoperative technique.

CONCLUSION

Proper design and execution of LCs allow for enhanced cosmesis and permit the cutaneous surgeon to progress to more technically advanced surgical procedures such as cutaneous flaps.