American Society of Plastic Surgeons
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nosemohs
one month ago
Answered

MOHS repair on nose

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.

Procedure: Skin Cancer Removal
Location: Media, PA

Replies 8

Karol Gutowski
ASPS Surgeon

Maybe a forehead flap or bilobed flap.

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Gary Culbertson
ASPS Surgeon
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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

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Rahul Vemula
ASPS Surgeon
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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

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Kristopher Day
ASPS Surgeon

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.

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Aaron Stone
ASPS Surgeon

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.

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nosemohs

In all honesty that photo was from almost 2 years ago. My plastic surgeon only did a skin graft (from my neck). I was left with a very deep crater and scarring. I recently had a flap to repair the crater and scarring. So far I am happy with the results.

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