Nasal Tip Surgical Reconstruction Options After Mohs Surgery

Nasal Tip Surgical Reconstruction Options After Mohs Surgery


[MUSIC] When a patient has a defect
after a skin cancer removal, by most surgery on
the tip of the nose. We have three sets of options
for how to reconstruct the nose to try to achieve as natural
a result as possible. The first type of procedure
would be a local flap. That means we use
skin on the nose, rearrange it to
close the defect. The second choice
would be a skin graft. And the third would be a stage
procedure like a forehead flap. So in brief, here are how we
think about those three options. When the defect is pretty small,
it’s fine to stretch the skin on the nose to close the hole,
essentially. It’s never simple. Reconstructing the tip of
the nose always involves some choices. But when it’s small,
we can do that. If the size of the defect gets a
little to large than we can’t do that and we have to bring
skin in from else where. So, we have two choices,
skin graft or something called
the forehead flap. So, basically the way I would
have you think about it is, a skin graphed is a much
simpler procedure. It requires only one stage, it’s
easily done as an out-patient. And very often, it can produce a result
that’s really, really good. But in general, the result with
a forehead flap will be better. The way to think about it is
it’s more likely that you’ll get a better result with a
forehead flap than a skin graft. But they both can produce
excellent results. So with a forehead flap,
it’s the gold standard. It can produce amazingly
good results, but there’s a lot more involved. It requires at least a two stage
procedure, and the placement of this forehead flap means
you have to live with this connection of tissue between
the forehead and the nose. So there’s a lot more involved. So the way I would have you
think about the three choices is, when it’s small enough,
a local flap can work great. But when the defect
is a little larger, we’re gonna choose between
skin graft and forehead flap. Skin graft can be
very effective. It’s much simpler and
easy to go through. Forehead flap in general is
gonna be a little more more predictable than it’s gonna
produce the best results but it’s a little more
to go through. The last detail I would
want you know about it is, if the skin graft is the
preferred choice, then we prefer to institute a delay between
the time of the main surgery and when we do the skin graft. In other words, we’ll have you
do the most surgery and then three to seven days later, come
back and do the skin graft then. The reason for that is it
allows a little time for the tissue to heal so the likelihood that the skin
graft will survive is better. If we choose forehead flap,
we don’t need to have a delay, we can do it the very next day
after skin cancer removal. I’m hopeful that these pros and cons will be helpful
in understanding the choices that you are facing. [MUSIC]

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