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Surgical Pearl on Reconstructing Surgical Defects of the Nasal Tip

View Article: PubMed Central - PubMed

ABSTRACT

Repairing surgical defects of the nasal tip is challenging, mainly because of the lack of freely mobile skin available peripherally. The Peng flap is a one-stage cutaneous flap that circumvents this difficulty by recruiting skin from the nasal dorsum and sidewall regions. The design produces a tridimensional shape perfectly adapted to the configuration of the nasal tip and allows for an inconspicuous closure of the defect. We present three examples of full-thickness skin defects involving the nasal tip, reconstructed using a modified version of the Peng flap, and present the experience at our department with this surgical technique.

No MeSH data available.


Related in: MedlinePlus

A) Flap design: the incisions (continuous lines) are started at the distal margins of the defect and continued laterally and superiorly; to facilitate the advancement movement the incisions can be extended up to the medial canthal region (interrupted lines); undermining of the flap in the submuscular plane (green) and surrounding regions in the subcutaneous plane (yellow) must be performed; a 30º central standing cone is removed and Burrow's triangles in the superior region of the flap may be excised if needed (white arrows); B) Surgical defect following excision of a nodular BCC on the nasal tip extending to the distal dorsum of the nose; C) Intraoperative view of flap prepared for final closure; D) Postoperative view of completed reconstruction; E and F) Results four months after the surgery.
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fig002: A) Flap design: the incisions (continuous lines) are started at the distal margins of the defect and continued laterally and superiorly; to facilitate the advancement movement the incisions can be extended up to the medial canthal region (interrupted lines); undermining of the flap in the submuscular plane (green) and surrounding regions in the subcutaneous plane (yellow) must be performed; a 30º central standing cone is removed and Burrow's triangles in the superior region of the flap may be excised if needed (white arrows); B) Surgical defect following excision of a nodular BCC on the nasal tip extending to the distal dorsum of the nose; C) Intraoperative view of flap prepared for final closure; D) Postoperative view of completed reconstruction; E and F) Results four months after the surgery.

Mentions: Herein we present three cases in which a modified version of a Peng flap was used to reconstruct skin defects following excision of BCCs on the nasal tip (one nodular, one micronodular and one morpheaform). Surgical excisions were performed with a 4-5 mm of clinically normal surrounding tissue. The resulting full-thickness skin defects measured between 1.6-2.0 cm in the horizontal plane and 1.6-2.2 cm in the vertical plane (Figure 1A-C). Wound closures were performed two weeks following the excision, after obtaining histopathology confirmation of tumor-free peripheral and deep margins. The design and intraoperative steps of the employed modified version of the Peng flap are represented in Figure 2.


Surgical Pearl on Reconstructing Surgical Defects of the Nasal Tip
A) Flap design: the incisions (continuous lines) are started at the distal margins of the defect and continued laterally and superiorly; to facilitate the advancement movement the incisions can be extended up to the medial canthal region (interrupted lines); undermining of the flap in the submuscular plane (green) and surrounding regions in the subcutaneous plane (yellow) must be performed; a 30º central standing cone is removed and Burrow's triangles in the superior region of the flap may be excised if needed (white arrows); B) Surgical defect following excision of a nodular BCC on the nasal tip extending to the distal dorsum of the nose; C) Intraoperative view of flap prepared for final closure; D) Postoperative view of completed reconstruction; E and F) Results four months after the surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134690&req=5

fig002: A) Flap design: the incisions (continuous lines) are started at the distal margins of the defect and continued laterally and superiorly; to facilitate the advancement movement the incisions can be extended up to the medial canthal region (interrupted lines); undermining of the flap in the submuscular plane (green) and surrounding regions in the subcutaneous plane (yellow) must be performed; a 30º central standing cone is removed and Burrow's triangles in the superior region of the flap may be excised if needed (white arrows); B) Surgical defect following excision of a nodular BCC on the nasal tip extending to the distal dorsum of the nose; C) Intraoperative view of flap prepared for final closure; D) Postoperative view of completed reconstruction; E and F) Results four months after the surgery.
Mentions: Herein we present three cases in which a modified version of a Peng flap was used to reconstruct skin defects following excision of BCCs on the nasal tip (one nodular, one micronodular and one morpheaform). Surgical excisions were performed with a 4-5 mm of clinically normal surrounding tissue. The resulting full-thickness skin defects measured between 1.6-2.0 cm in the horizontal plane and 1.6-2.2 cm in the vertical plane (Figure 1A-C). Wound closures were performed two weeks following the excision, after obtaining histopathology confirmation of tumor-free peripheral and deep margins. The design and intraoperative steps of the employed modified version of the Peng flap are represented in Figure 2.

View Article: PubMed Central - PubMed

ABSTRACT

Repairing surgical defects of the nasal tip is challenging, mainly because of the lack of freely mobile skin available peripherally. The Peng flap is a one-stage cutaneous flap that circumvents this difficulty by recruiting skin from the nasal dorsum and sidewall regions. The design produces a tridimensional shape perfectly adapted to the configuration of the nasal tip and allows for an inconspicuous closure of the defect. We present three examples of full-thickness skin defects involving the nasal tip, reconstructed using a modified version of the Peng flap, and present the experience at our department with this surgical technique.

No MeSH data available.


Related in: MedlinePlus