‘Best of the Best’ solutions to challenging reconstructive surgery of the nose

The nose, with its unique and individual topography, presents particular challenges for reconstructive and skin cancer surgeons. A number of approaches can be adopted, but how does the dermatologic surgeon choose the best for any particular defect?

Reconstructive Conundrums in Dermatology: The Nose provides an atlas compendium of novel approaches to these challenges. Based on the Reconstructive Conundrum series published in the journal Dermatologic Surgery, a range of cases provide photographs of the defect before and immediately after reconstruction, and two long-term, follow-up images. The authors provide a detailed explanation for their choice of reconstruction. The Editors’ commentaries allow residents and experienced surgeons alike to compare different reconstructive alternatives and to explore the thought processes behind them.

The 30 conundrums each provide a full background to the problem and the strategies underpinning successful surgical solution. They have been grouped into nasal subunits covering:

• Nasal dorsum
• Nasal sidewall
• Nasal tip
• Nasal ala
• Alar groove
• Alar rim

Jam packed with clinical wisdom and surgical pearls, Reconstructive Conundrums in Dermatologic Surgery: The Nose provides a guiding hand to anyone faced with daunting surgical reconstructions.

Contents

Part I Nasal Dorsum

۱ Combined Linear Closure and Burow’s Graft for a Dorsal Nasal Defect

۲ Reconstruction of Two Nasal Defects Following Mohs Surgery

۳ Repair of Adjacent Nasal Defects with One Double-Rotation Flap Closure

۴ Contralateral Nasolabial Flap for a Large Nasal Defect

Part II Nasal Sidewall

۵ Dual Nasal Sidewall and Lip Defects Combined into a Single Arcuate Advancement Flap

۶ Advancement Flap in the Reconstruction of a Lateral Nasal Sidewall Defect

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

Part III Nasal Tip

۸ The Dorsal Nasal Flap for Reconstruction of Large Nasal Tip Defects

۹ Adjunctive Use of Primary Nasal Tip Closure to Facilitate Local Flap Closure of Challenging Nasal Defects

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

۱۱ Nasal Tip Wound Repair Using a Rhombic Transposition Flap with a Double Z-Plasty at Its Base

Part IV Nasal Ala

۱۲ Spiral Subcutaneous Island Pedicle Advancement Flap for Repair of Alar Defects

۱۳ Combined Hinge Flap Full-Thickness Skin Graft for a Through-and-Through Nasal Defect

۱۴ Combined Hinge and Nasolabial Transposition Flap for Repair of a Full-Thickness Nasal Alar Defect

Part V Alar Groove/Perialar Defects

۱۵ Shark Island Pedicle Flap for Repair of Combined Nasal Ala-Perialar Defects

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

۱۷ Dog-Ear Island Pedicle Flap for Repair of Ala and Nasal Wall Defects

Part VI Alar Rim

۱۸ Repair of an Alar Defect

۱۹ Reconstruction of a Full Thickness Soft Triangle Defect

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

۲۱ Reconstruction of an Alar Rim Defect

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

۲۳ Revisionary Technique for Alar Rim Notching: The Stair-Step Flap

۲۴ Reconstruction of a Surgical Defect Involving the Nasal Ala and Alar Crease

۲۵ One-Stage Reconstruction of a Full-Thickness Nasal Defect Involving the Alar Rim

۲۶ Repair of a Defect on the Ala

۲۷ Single-Stage Reconstruction of a Combined Upper Lip and Nasal Ala Defect

۲۸ Nasal Dorsum Transposition Flap for Closure of an Alar Rim Defect

۲۹ Bilobed Flap for Full-Thickness Nasal Defect: A Common Flap for an Uncommon Indication

۳۰ One-Stage Reconstruction Following Complete Alar Loss