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Rickstrew J, Neill BC, Downing M, Cappel JA, Tolkachjov SN. Nasal tip rotation flap for reconstruction of surgical defects on the distal nose. Int J Dermatol 2024. [PMID: 38745345 DOI: 10.1111/ijd.17155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The nose is a common site for the development of skin cancers. Mohs micrographic surgery (MMS) is a highly curative treatment for skin cancer of the nose. Reconstruction of MMS defects on the nose, especially on the distal aspect, can be challenging given the proximity of multiple subunits and limited adjacent tissue reservoirs. Our goal was to describe our experience using a nasal tip rotation flap (NTRF) for MMS defects on the distal nose. METHODS A retrospective review of all MMS cases at multiple institutions between June 2018 and June 2022 was undertaken. Cases that used an NTRF to repair the MMS defect(s) were selected, and data were collected on patient demographics, tumor type, anatomical location of the tumor, preoperative and postoperative size, number of stages needed to clear the tumor, repair dimensions, and any postoperative complications. RESULTS A total of 66 cases that utilized an NTRF for reconstruction were included. The mean preoperative tumor size was 0.8 cm (range: 0.3-1.6 cm), and the mean defect size was 1.2 cm (range: 0.7-1.9 cm). The defects were most commonly on the nasal tip. There were no significant complications observed. CONCLUSIONS The nasal tip rotation flap is a reliable reconstruction option for MMS defects of the distal nose. This flap can be used for defects that involve the nasal tip, soft triangle, and/or portions of the ala, including the alar rim.
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Affiliation(s)
| | | | | | | | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, TX, USA
- Division of Dermatology, Baylor University Medical Center, Dallas, TX, USA
- Department of Dermatology, University of Texas at Southwestern, Dallas, TX, USA
- Texas A&M College of Medicine, Dallas, TX, USA
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Hifny MA, Park TH. The Versatility of Keystone Flaps for Skin Cancer Reconstruction of the Nose. J Craniofac Surg 2023:00001665-990000000-01147. [PMID: 38306184 DOI: 10.1097/scs.0000000000009799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/26/2023] [Indexed: 02/04/2024] Open
Abstract
Nasal reconstruction has been a challenging problem for even the most experienced surgeon to provide excellent esthetic and functional outcomes. Although the bilobed flap offers distinct advantages for reconstructing these defects using an adjacent tissue with similar esthetic qualities, this flap has several potential limitations. The authors hypothesized that the conventional keystone flap and its variants provide a versatile and easily reproducible reconstructive option for nasal reconstruction after wide skin cancer excision. The authors retrospectively reviewed 12 consecutive soft tissue reconstruction data using 3 types of keystone flaps between May 2021 and July 2023. The authors reviewed all patients who underwent reconstruction with the keystone flap or its modification to repair cutaneous nasal defects following wide skin cancer excision. The authors reconstructed small- to medium-sized nasal defects ranging from 1×1 to 2.5×2.5 cm2 with a mean size of 1.2×1.1 cm2 using either a conventional keystone flap or its modification, including the Omega variant and rotation Hemi-keystone flap. All patients were satisfied with the esthetic outcomes. Keystone flaps are a versatile option for reconstructing the nose after cancer surgery. This strategy obviates the need for a bilobed flap after cancer removal in the nose.
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Affiliation(s)
- Mahmoud A Hifny
- Department of Plastic Surgery, Faculty of Medicine, Qena University Hospital, South Valley University, Qena, Egypt
| | - Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
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Wang P, Fan Y, Lian W, Su Y, Xiao H, Jia C. Satisfactory Wound Reconstruction with a Local Rotation Flap After Removal of Large Penile Divided Nevi: Original Technique, Early and Mid-Term Results. Clin Cosmet Investig Dermatol 2022; 15:2203-2210. [PMID: 36281267 PMCID: PMC9587707 DOI: 10.2147/ccid.s383514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the application of local rotation flaps for reconstruction of divided nevi of the penises in young male patients. METHODS A group of 8 patients of divided nevi of the penises who underwent wound reconstruction with local rotation flaps after surgical lesion removal was enrolled in a retrospective clinical study. Postoperative complication, sexual function and psychological traits were evaluated during the follow-up. RESULTS All patients, with ages ranged from 16 to 32 years (mean 23.25 years), were followed up for 6 to 48 months (mean 19.86 months). The patient's average length of hospital stay was 7.85 day (7 to 15 days). The average dimension of the lesions was (2.31±0.44) × (1.46±0.48) cm2 on the glans and (1.38±0.40) × (1.01±0.46) cm2 on the inner prepuce plate. All patients had no postoperative infection and were satisfied with the postoperative outcome upon discharge. Five cases of benign intradermal nevi and 3 cases of compound nevi without malignant transformation were confirmed by pathological evaluation on the removed samples. The sexual function of all patients was unaffected postoperatively by male sexual function scale (BMSFI and IIEF-5) evaluation. The psychological status of depression, anxiety and stress was all improved after the surgical reconstruction confirmed by the psychological traits scale (DASS) evaluation. CONCLUSION Reconstruction with the local rotation flap is a simple, safe and appropriate surgical procedure, achieves satisfactory cosmetic outcome, and maintains intact male sexual function when used for the repair of defect after removal of divided nevi of the penises.
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Affiliation(s)
- Peng Wang
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, People’s Republic of China,Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Yueying Fan
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Wenqin Lian
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Yingjun Su
- Department of Burns and Plastic Surgery, Plastic Surgery Hospital, Xi’an International Medical Center, Xi’an, People’s Republic of China
| | - Hou’an Xiao
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, People’s Republic of China,Hou’an Xiao, Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, People’s Republic of China, Email
| | - Chiyu Jia
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China,Correspondence: Chiyu Jia, Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China, Email
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Rubino C, Trignano E, Trignano C, Pinna M, Serra PL. Reconstruction of a fistula in the anterior soft triangle of the nose after basal cells carcinoma excision: A case report. Int J Surg Case Rep 2022; 95:107225. [PMID: 35662035 PMCID: PMC9168610 DOI: 10.1016/j.ijscr.2022.107225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Basal cell carcinomas represent the most frequent skin cancer and the nose is the most common site of presentation. This has an impact on both aesthetics and function of the nose and consequences in patients' psyche. Case presentation In our paper, the first case in literature of a cutaneous fistula in the nasal soft triangle, after a basal cell carcinoma excision, and its reconstruction, is reported. Clinical discussion One of the areas of weakness of the nose is the anterior soft triangle; here, any minimal alteration of the anatomy can potentially lead to severe impairment. Conclusion When the nasal soft triangle is damaged, its restoration is crucial. Our technique showed both functional and aesthetic good result. The nose is the most common site of presentation of basal cell carcinomas. One of the areas of weakness of the nose is the anterior soft triangle. In our paper, the first case in literature of a cutaneous fistula in the nasal soft triangle is reported. The reconstruction consisted of two steps: first to restore the inner layer, second to cover the new inner layer. Aesthetic and functional outcomes were considered excellent by both the surgeon and the patient.
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Affiliation(s)
- Corrado Rubino
- University of Sassari, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, Plastic Surgery Unit, Sassari, Italy
| | - Emilio Trignano
- University of Sassari, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, Plastic Surgery Unit, Sassari, Italy
| | - Claudia Trignano
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy
| | - Michela Pinna
- University of Sassari, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, Plastic Surgery Unit, Sassari, Italy
| | - Pietro Luciano Serra
- University of Sassari, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, Plastic Surgery Unit, Sassari, Italy; University of Sassari, School of Specialization in Plastic, Reconstructive and Aesthetic Surgery.
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Fournier S, Blouin MM, Alain J. Repair of a Large Nasal Tip and Soft Triangle Defect. Dermatol Surg 2021; 47:1616-1618. [PMID: 34115687 DOI: 10.1097/dss.0000000000003111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Suzel Fournier
- CHU de Quebec-Hotel-Dieu de Quebec, Dermatology Department, Université Laval, Quebec, Quebec, Canada
| | - Marie-Michèle Blouin
- CHU de Quebec-Hotel-Dieu de Quebec, Dermatology Department, Université Laval, Quebec, Quebec, Canada
| | - Jimmy Alain
- Victoria Park Medispa Quebec, Quebec, Quebec, Canada
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Tolkachjov SN. Two Large Nasal Tip Defects Involving the Soft Triangle, Alar Rim, and Alar Groove. Dermatol Surg 2021; 47:1645-1647. [PMID: 33625150 DOI: 10.1097/dss.0000000000002723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stanislav N Tolkachjov
- Dermatology and Mohs Micrographic & Reconstructive Surgery, Epiphany Dermatology, Dallas, Texas
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Use of Keystone Flaps in Consideration of the Facial Aesthetic Subunit Concept as an Alternative Reconstructive Option for Nasal Defect Coverage. J Craniofac Surg 2021; 32:1864-1869. [PMID: 33351545 DOI: 10.1097/scs.0000000000007359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Nasal defect coverage has some challenging aspects for plastic surgeons because of the midfacial location of the nose and the relationship between convexities and concavities of nasal subunits. The authors described our experience with performing keystone flap (KF) nasal reconstruction in accordance with the facial aesthetic subunit concept and demonstrated the expanding versatility of KFs in nasal reconstruction. Between January 2017 and February 2020, 15 patients (average age, 72.07 ± 13.00 years, range: 38-88 years) underwent KF reconstruction for nasal defects. We performed KF reconstruction in accordance with the facial aesthetic subunit concept. Data, including the defect causes and locations, defect sizes, flap sites and sizes, types of KFs, flap survival, complications, and follow-up period for each patient were reviewed retrospectively. Cosmetic outcomes were evaluated by independent plastic surgeons and patients through satisfactory postoperative surveys. Sixteen defects occurred in 15 patients. The defect sizes ranged from 0.8 × 1 cm to 2.5 × 3 cm. The flap sizes ranged from 1.5 × 3.5 cm to 4 × 6 cm. All defects were successfully covered with KFs from adjacent subunits. All flaps survived without any postoperative complications. At the mean follow-up period of 8.33 ± 2.92 months, the objective cosmetic outcomes were rated favorably, and the average subjective patient satisfaction score was 7.93 ± 1.28 on a scale of 1 to 10. We suggest that using KF reconstruction in consideration of the facial aesthetic subunit concept can be a promising alternative modality for covering nasal defects with outstanding aesthetic outcomes.
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Wright L, Grunzweig KA, Totonchi A. Nasal Obstruction and Rhinoplasty: A Focused Literature Review. Aesthetic Plast Surg 2020; 44:1658-1669. [PMID: 32328743 DOI: 10.1007/s00266-020-01710-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a significant variation in the assessment, treatment, and outcomes of nasal airway obstruction and management in the published literature. This study aimed to: (1) define key components of the nasal airway, (2) identify frequent causes of nasal obstruction, and (3) review existing treatment methods. METHODS A systematic review of the literature was performed, and 135 studies were included via the following criteria: English, human subjects, and a primary endpoint of nasal airway improvement. Exclusion criteria were: abstract only, no airway data, pediatric patients, cleft rhinoplasty, sleep apnea, isolated traumatic nasal reconstruction, and cadaveric-only or animal studies. RESULTS The relevant obstructive sites include the ENV, septum, inferior turbinates, INV, and nasal bones. Addressing the alar rim alone may be insufficient, and inspection of the lateral wall and crura may be indicated. Correction of septal deviation involves attention to the bony base. Mucosal sparing treatment of inferior turbinates improves outcomes. INVs are a major source of nasal obstruction, and treatment includes spreader grafts. The bony nasal vault can contribute to nasal obstruction, including due to surgical osteotomies. CONCLUSIONS Anatomic causes of airway obstruction include the alar rims and lateral nasal walls, deviated nasal septum, inferior turbinate hypertrophy, decreased INV angle, and narrowed nasal bones. Treatments include graft placement; septoplasty; mucosal sparing turbinectomy; and lateral wall support. Pitfalls include failing to address the bony septum, over-resection of inferior turbinates, and narrowing of the nasal vault. Appreciation of airway management during rhinoplasty will improve functional outcomes. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Lauren Wright
- Hurwitz Center for Plastic Surgery, Pittsburgh, PA, 15313, USA
| | - Katherine A Grunzweig
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Ali Totonchi
- MetroHealth System, Case Western Reserve University, Cleveland, OH, 44113, USA.
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V-Y Flap for Nasal Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3040. [PMID: 32983792 PMCID: PMC7489650 DOI: 10.1097/gox.0000000000003040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022]
Abstract
The nasal tip is a complex zone for reconstruction. Numerous flap reconstructions have been proposed. In addition to the technique presented here, only the Gillies-Millard bishop’s miter flap and the paramedian forehead flap should be considered. The bilobed flap should be discontinued. The double-opposing V-Y flap for nasal tip reconstruction described here is an excellent method for reconstruction of limited defects of the nasal tip. These are mirror-image cutaneous flaps which require careful, skillful technique to preserve the delicate nerves and vessels. This challenging technique should only be attempted by qualified surgeons. Triangular cutaneous flaps are marked on either side of the defect, oriented transversely. The flaps are elevated and advanced with careful, gentle dissection. Ligamentous structures are cut while preserving the neurovascular supply. No cautery is used. The procedure is performed in an operating room with local anesthesia and with the patient under IV sedation. A patient who underwent this reconstruction is shown preoperatively, early postoperatively, and late postoperatively. The results demonstrate no tip distortion with imperceptible scars. The steps to undertake this procedure are outlined in detail. Rules for nasal tip reconstruction are proposed.
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Abstract
INTRODUCTION The nasal defect is still a challenge for plastic surgeon now. Many surgical options are reported in previous literatures. There are few studies reported about the 1-staged repair of large nasal defect. In this article, the authors describe the experience about the nasal reconstruction in the last 8 years. PATIENTS AND METHODS Fifty-two patients diagnosed with nasal defect were retrospectively examined between 2011 and 2018. All of them performed under local anesthesia and received 1-staged surgical method. RESULTS In the authors' patients, the mean size of the defect was 2.16 cm. Nine patients were treated by nasolabial flap, and 30 patients were treated by local flap. The modified auricular composite tissue flap was used in 5 patients. There were no major postoperative complications. All patients were satisfied with aesthetically nasal contours as well as inconspicuous scars when follow-up. CONCLUSION Single-staged reconstruction is still considered the first choice for nasal defect. The design of flap depends on the surrounding condition and the size of defect. Locoregional flaps are still considered as an ideal choice for nasal reconstruction in most patients. O-Z flap and modified auricular free flap could be an option for large-sized defect of nasal alar and nasal tip.
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Tolkachjov SN. Nasal tip rotation flap to avoid paramedian forehead flap for large nasal tip and alar defects. J Am Acad Dermatol 2020; 85:e243-e244. [PMID: 32068041 DOI: 10.1016/j.jaad.2020.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 11/24/2022]
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Commentary on The Nasal Tip Rotation Flap for Reconstruction of the Lateral Nasal Tip, Anterior Ala, and Soft Triangle. Dermatol Surg 2017; 43:1233-1235. [PMID: 28902031 DOI: 10.1097/dss.0000000000001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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