I'm wondering what the most likely method of repair would be after this MOHS surgery? As you can see the surgery was extensive and I'm wondering what the best course of action would be.
Maybe a forehead flap or bilobed flap.
nosemohs,
Usually the defects are closed very soon after the Moh's surgery is performed. Did you have a Slow Moh's procedure & the wound is still open/unrepaired?
Best,
Gary R Culbertson, MD
This is a severe defeat that is full thickness. I think the best repair would be as flap surgery and you will most likely need multiple stashes
This appears to be a full-thickness defect of the lower third nasal sidewall encroaching onto the nasal tip and nasal ala. I would assume it is over 1.5-2 cm in greatest dimension, which would make it too large for a bilobed or other "geometric" (borrow from adjacent tissue) flap. Therefore, while one could consider a nasolabial (borrow from the "smile line") flap, in my hands this would likely be best reconstructed with a so-called "paramedian forehead flap," which would be performed in two surgical stages. It would be good to speak with a board-certified plastic surgeon that performs facial reconstruction.
I prefer a bipedicled dorsal nasal V-Y flap for the outer layer. In my experience it gives the best long term result in a single stage. if the cartilage is involved cartilage grafts and mucosal surgery will also be required for the deeper layers.