By Desiree S. Ratner, Joel L. Cohen MD, David Brodland
"Facial wound reconstruction following dermatologic surgical procedure for melanoma excision, or different reason for disfigurement, is likely one of the extra tough systems a dermatologist can perform. not just does the wound must be clinically sound, the cultured specifications from sufferers are excessive, and the nostril and surrounding parts are specially challenging.This publication, in accordance with step by step case reports released in Dermatologic surgical procedure (the magazine of the yankee Society of Dermatologic Surgery), will introduce the foundations of reconstruction and various 'how to' techniques for nasal reconstructive surgical procedure protecting the alternative of graft for the placement after which the surgical strategy essential to in achieving optimum success.Each case will supply a dialogue of the actual reconstruction wanted, the potential demanding situations, the answer selected and an illustrated 'how to' description of the procedure"--Provided by means of publisher. Read more...
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Extra resources for Reconstructive conundrums in dermatologic surgery : the nose
The cheek is almost always an ample source for donor skin. 1 Not all noses have a great deal of midline laxity, however, in appropriately selected cases, 1 cm or more of flap skin may be available. I note on Figure 3 what appears to be a small area of necrosis visible at the confluence of the alar crease and nasofacial junction. I believe that this is most likely due to the length of the incision made on the medial-most portion of the transposition flap. I would submit that this incision need only extend superiorly to the level of the tissue island over which the flap will be transposed.
Correct placement of these sutures to recreate the contour of the nasofacial sulcus entails a vertically oriented suture “bite,” usually at the most lateral aspect of the nasal bone. The flap is then pulled into position using a skin hook, and the corresponding location on its undersurface is identified by envisioning where the new “sulcus” should be once it is sutured into place. The suture needle is passed with a small bite perpendicular to the direction of arterial blood flow so as to avoid inadvertent suture constriction of vital vessels.
D) Frontal and (e) caudal nasal views 11 months after surgery. primary nasal tip closure to decrease wound size before bilobed flap reconstruction. The first step of her reconstruction was to excise a standard Burow’s triangle from the caudal apex of the primary defect, which extended half the distance down the columella. After closure of this nasal tip Burow’s triangle, a standard bilobed flap was designed and executed in standard fashion, taking care to undermine widely in the subnasalis plane.
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