Reconstructive Conundrums in Dermatologic Surgery

‘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.

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