Reconstructive Conundrums in Dermatologic Surgery

Desiree S Ratner, MD, Director of Dermatologic Surgery at the Columbia University Medical Center, Co-director of the Multidisciplinary Melanoma Center at the Columbia University Medical Center, Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University. Joel L. Cohen, MD Director of AboutSkin Dermatology and DermSurgery in Englewood and Lone Tree, Colorado and Assistant Clinical Professor, University of Colorado. David Brodland, MD, Assistant Clinical Professor, Department of Dermatology, University of Pittsburgh and Department of Dermatology UPMC Shadyside Hospital, Pittsburgh, PA.

Introduction, vii

Part I Nasal Dorsum, 1

1 Combined Linear Closure and Burow’s Graft for a Dorsal Nasal Defect, 3

2 Reconstruction of Two Nasal Defects Following Mohs Surgery, 9

3 Repair of Adjacent Nasal Defects with One Double-Rotation Flap Closure, 13

4 Contralateral Nasolabial Flap for a Large Nasal Defect, 19a

Part II Nasal Sidewall, 23

5 Dual Nasal Sidewall and LipDefects Combined into a Single Arcuate Advancement Flap, 25

6 Advancement Flap in the Reconstruction of a Lateral Nasal Sidewall Defect, 31

7 Repair of the Left Nasal Sidewall, Nasofacial Sulcus,and Medial Cheek, 35

Part III Nasal Tip, 41

8 The Dorsal Nasal Flap for Reconstruction of Large Nasal Tip Defects, 43

9 Adjunctive Use of Primary Nasal Tip Closure to Facilitate Local Flap Closure of Challenging Nasal Defects, 49

10 Repair of a Large, Exposed-Cartilage Nasal Tip Defect Using Nasalis-Based Subcutaneous Pedicle Flaps and Full-Thickness Skin Grafting, 55

11 Nasal TipWound Repair Using a Rhombic Transposition Flap with a Double Z-Plasty at Its Base, 63

Part IV Nasal Ala, 69

12 Spiral Subcutaneous Island Pedicle Advancement Flap for Repair of Alar Defects, 71

13 Combined Hinge Flap Full-Thickness Skin Graft for a Through-and-Through Nasal Defect, 75

14 Combined Hinge and Nasolabial Transposition Flap for Repair of a Full-Thickness NasalAlarDefect, 79

Part V Alar Groove/Perialar Defects, 85

15 Shark Island Pedicle Flap for Repair of Combined Nasal Ala-Perialar Defects, 87

16 “Jigsaw Puzzle” Advancement Flap for Repair of a Surgical Defect Involving the Lateral Nasal Ala, 93

17 Dog-Ear Island Pedicle Flap for Repair of Ala and NasalWall Defects, 99

Part VI Alar Rim, 105

18 Repair of an Alar Defect, 107

19 Reconstruction of a FullThickness Soft Triangle Defect, 113

20 A Tunneled and Turned-Over Nasolabial Flap for Reconstruction of Full-Thickness Nasal Ala Defects, 119

21 Reconstruction of an Alar Rim Defect, 127

22 Island Pedicle Flaps for Repair of a Nose, Cheek,and Lip Defect, 131

23 Revisionary Technique for Alar Rim Notching:The Stair-Step Flap, 137

24 Reconstruction of a Surgical Defect Involving the Nasal Ala and Alar Crease, 145

25 One-Stage Reconstruction of a Full-Thickness Nasal Defect Involving the Alar Rim, 151

26 Repair of a Defect on the Ala, 157

27 Single-Stage Reconstruction of a Combined Upper Lip and Nasal Ala Defect, 163

28 Nasal Dorsum Transposition Flap for Closure of an Alar Rim Defect, 169

29 Bilobed Flap for Full-Thickness Nasal Defect:A Common Flap for an Uncommon Indication, 175

30 One-Stage Reconstruction Following Complete Alar Loss, 181

Index, 187