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Table of Contents
CORRESPONDENCE
Year : 2022  |  Volume : 40  |  Issue : 4  |  Page : 257-258

Lateral nasal dorsum defect reconstruction with contralateral supra-alar groove cresentic advancement flap


Department of Dermatology, Kishiwada City Hospital, Kishiwada, Japan

Date of Submission31-May-2022
Date of Decision21-Oct-2022
Date of Acceptance21-Oct-2022
Date of Web Publication09-Dec-2022

Correspondence Address:
Dr. Takahiro Shiratori
Department of Dermatology, Kishiwada City Hospital, Kishiwada
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1027-8117.363058

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How to cite this article:
Shiratori T, Yoshida M. Lateral nasal dorsum defect reconstruction with contralateral supra-alar groove cresentic advancement flap. Dermatol Sin 2022;40:257-8

How to cite this URL:
Shiratori T, Yoshida M. Lateral nasal dorsum defect reconstruction with contralateral supra-alar groove cresentic advancement flap. Dermatol Sin [serial online] 2022 [cited 2023 Feb 8];40:257-8. Available from: https://www.dermsinica.org/text.asp?2022/40/4/257/363058



Dear Editor,

Nose reconstruction requires esthetically pleasing results due to the location of the external nose at the center of the face and thus its important role in the appearance. The esthetic units of the face have previously been described.[1] It is important for the resulting scar to match the esthetic unit.[2]

The bilobed flap, nasolabial flap, Limberg flap, axial frontonasal flap, forehead flap, and so on are well-known reconstruction methods for skin defects following the excision of skin tumors from the nasal dorsum to the lateral side of the dorsum. In this study, we performed the crescentic advancement flap technique in the two cases for the reconstruction of dorsal nasal skin defects and were able to correct the dog ear scar in the contralateral supra-alar groove to achieve esthetically pleasing results. Herein, we report the effectiveness of this reconstruction method for skin defects from the supra-alar groove of the nasal dorsum to the lateral nasal dorsum.

Case 1

A 78-year-old Japanese woman visited our hospital with a gradual increase in the dark brown region on the right dorsum of the nose that had been present for 2 years. Basal cell carcinoma was diagnosed based on skin biopsy results, and under local anesthesia, the tumor was resected along the perichondrium with a 4-mm margin. A 16 mm × 15 mm skin defect subsequently resulted from tumor resection, and reconstruction by crescentic advancement flap was performed [Figure 1]a, [Figure 1]b and [Figure 1]c. At a follow-up examination 3 months later, the wound was inconspicuous, and the patient was satisfied with her appearance [Figure 1]d and [Figure 1]e.
Figure 1: (a) The incision line and flap are designed with a 4-mm margin from the basal cell carcinoma on the right nasal dorsum. (b-c) The flap is dissected from the perichondrium. (d-e) Suture scars are no longer noticeable 1 month postoperatively.

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Case 2

A 77-year-old Japanese woman visited the hospital with a black dome-shaped nodule on the left nasal dorsum that had been present for 3 years. Basal cell carcinoma was diagnosed based on the skin biopsy results. Under local anesthesia, the tumor was resected along the perichondrium with a 3-mm margin [Figure 2]a. A skin defect (14 mm × 14 mm) occurred after the tumor resection, and reconstruction was performed using the crescentic advancement flap technique [Figure 2]b. At a follow-up examination 8 months later, the wound was less noticeable, and the patient was satisfied with her appearance [Figure 2]c and [Figure 2]d.
Figure 2: (a) The incision line and flap are created with a 3-mm margin from the basal cell carcinoma on the left nasal dorsum. (b) After completion of the surgery. (c-d) Suture scars are no longer noticeable 8 months postoperatively.

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Both cases were nodular basal cell carcinoma, and their margins were negative.

Since the 1980s, there have been the cases of crescentic advancement flaps that create a Burow's triangle in the alar groove to make the wound less noticeable.[2],[3],[4] In one report, a flap was created from the same side as that of the skin defect. In our case, however, we created a crescentic advancement flap that straddled the dorsal nasal midline from the contralateral side of the skin defect. This type of reconstruction had two main advantages: (1) The suture marks were mostly similar to relaxed skin tension lines, the Langer lines, and the supra-alar groove; therefore, the wound was inconspicuous. (2) The color and texture of the skin matched better than that when a flap from the cheek was used. Intraoperatively, the flap could be raised to maintain a wide field of view, which facilitated some processes, such as hemostasis.

While the dissection range is wide, there are the few elements of rotation with crescentic advancement flaps. Hence, blood circulation disorders and deformation are unlikely to occur, and the procedure and flap design are simple.

This technique can be one of the best options with good patient acceptance.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985;76:239-47.  Back to cited text no. 1
    
2.
Hill TG. The perialar arc rotation skin flap. J Dermatol Surg Oncol 1989;15:78-83.  Back to cited text no. 2
    
3.
Mellette JR Jr., Harrington AC. Applications of the crescentic advancement flap. J Dermatol Surg Oncol 1991;17:447-54.  Back to cited text no. 3
    
4.
Yoo SS, Miller SJ. The crescentic advancement flap revisited. Dermatol Surg 2003;29:856-8.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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