Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents     
CORRESPONDENCE  
Year : 2017  |  Volume : 10  |  Issue : 1  |  Page : 54-55
Reconstruction with dorsal nasal flap after excision of basal cell carcinoma of the nose


1 Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

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Date of Web Publication17-Apr-2017
 

How to cite this article:
Jena A, Gangasani R, Reddy NR, Patnayak R. Reconstruction with dorsal nasal flap after excision of basal cell carcinoma of the nose. J Cutan Aesthet Surg 2017;10:54-5

How to cite this URL:
Jena A, Gangasani R, Reddy NR, Patnayak R. Reconstruction with dorsal nasal flap after excision of basal cell carcinoma of the nose. J Cutan Aesthet Surg [serial online] 2017 [cited 2020 Apr 1];10:54-5. Available from: http://www.jcasonline.com/text.asp?2017/10/1/54/204572




Sir,

Reconstruction of nasal defect after excision of a neoplasm is a surgical challenge due to the complex three-dimensional structure involving different components of the nose. Repair of the resultant defect is difficult and should be aesthetically acceptable.[1] The method of repair is based on the defect's size, location and structural involvement (i.e., skin, cartilage, bone, mucosa).[2] Local flaps are preferable as they provide better match for color and texture.[3]

Basal cell carcinoma (BCC) of the nose is common with a high recurrence rate. A wide variety of surgical techniques are available which assure complete tumour removal with good aesthetic and functional outcome.[4]

A 72-year-old male presented with a 2 cm × 2 cm ulcer over the dorsum of nose for the last 6 months. Another small, pigmented ulcerated lesion of size 4 mm × 4 mm was present below the right medial canthus [Figure 1]. Dorsal nasal flap was used to reconstruct the resultant defect.
Figure 1: Ulcer over the dorsum of nose

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Incision site was marked to include the lesion over the nose. The donor site flap was also designed and marked [Figure 2]a. Wide excision of the nasal skin lesion was done taking 3 mm margin all around. The flap was raised in subcutaneous layer extending to glabella based on the right-sided vascular pedicle [Figure 2]b. The flap was rotated to cover the defect and sutured. The lesion below the right medial canthus was also excised and primary suturing was done [Figure 2]c.
Figure 2: (a) lesion over the dorsum of nose and donor flap site marked. (b) defect after excision of lesion and raised dorsal nasal flap. (c) flap was rotated to cover the defect and sutured

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All the sutures were removed on the 7th post-operative day [Figure 3]a. Histopathology was reported as BCC. After 2-month follow-up, the patient was asymptomatic with good aesthetic appearance [Figure 3]b.
Figure 3: (a) Seventh post-operative day picture after suture removal. (b) Picture after 2 months

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BCC is the most common non-melanoma skin cancer. It accounts for up to 25%–30% of tumours of the face. The nose has a 2.5 times higher risk of recurrence of BCC after surgical excision due to its anatomical peculiarities and problems in pre-surgical identification of tumour margins. Despite this, surgery is the mainstay of treatment of BCC of the nose.[4]

Cover of nasal defects after cancer-ablative surgeries include numerous reconstructive modalities such as free skin grafting and local flaps.[5]

Dorsal nasal flap (Rieger) is time tested and provides good aesthetic result and is a single-staged procedure. This modified rotation flap recruits redundant skin from the glabella. It can be used to repair skin defects of the nasal tip, dorsum and sidewall. It utilises the entire dorsal nasal skin to facilitate repair. It can repair relatively large lower and mid-nasal defects, measuring 2.5 cm or less with matching adjacent tissue with an exact colour, thickness and contour. It is a safe flap, and the donor site morbidity is minimal. Although originally described to repair the defects of lower third of nose, a little modification can repair the defects of the dorsum of the nose with good outcome.[5] The disadvantage of the flap is limitation regarding size of the defect and the need to elevate an extensive area of nasal tissue.

Our patient had an uneventful post-operative recovery with acceptable cosmetic appearances. Currently, he is doing well.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Zavod MB, Zavod MB, Goldman GD. The dorsal nasal flap. Dermatol Clin 2005;23:73-85, vi.  Back to cited text no. 1
    
2.
Abernathie BL, Granick M. Nasal reconstruction after basal cell excision. Eplasty 2013;13:ic10.  Back to cited text no. 2
    
3.
Zimbler MS, Thomas JR. The dorsal nasal flap revisited: aesthetic refinements in nasal reconstruction. Arch Facial Plast Surg 2000;2:285-6.  Back to cited text no. 3
    
4.
Wollina U, Bennewitz A, Langner D. Basal cell carcinoma of the outer nose: Overview on surgical techniques and analysis of 312 patients. J Cutan Aesthet Surg 2014;7:143-50.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Fliss DM, Freeman JL. The nasal glabellar flap. J Otolaryngol 1994;23:6-7.  Back to cited text no. 5
    

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Correspondence Address:
Amitabh Jena
Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCAS.JCAS_128_15

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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