Journal of Plastic, Breast & Reconstructive Surgery·Relatos de casos cirúrgicos revistos por pares, de acesso abertoRevisto por pares · Acesso aberto
Julie Husted Andersen. Case 6 (2023): Nasal reconstruction with bilateral nasolabial flaps. Journal of Plastic, Breast & Reconstructive Surgery. 2023.
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Julie Husted Andersen
75 year old woman with a history of basal cell carcinoma (nBCC) located to the apex of the nose. The first biopsy was made in 2014. Since then the patient suffered a relapse and in september 2022 the excision was made with a surgical margin of 5 mm. The defect was left open until final histology. Histology showed that the tumor was radically excised and now ready for planning of a facial flap.
BeforeAfter75 year old woman with a history of basal cell carcinoma (nBCC) located to the apex of the nose. The first biopsy was made in 2014. Since then the patient suffered a relapse and in september 2022 the excision was made with a surgical margin of 5 mm. The defect was left open until final histology. Histology showed that the tumor was radically excised and now ready for planning of a facial flap.
The surgery was originally planned for excision and use of per-operative freezing histology with reconstruction of a random facial flap. Due to the difficulty defining the borders of the tumor it was decided not to use the per-operative freezing histology. Instead it was decided to leave the defect open until final histology. Reconstruction with a random flap were discussed for the 2-step-procedure. It was assessed that a bilateral nasolabial flap could cover the defect on the apex of the nose or alternatively a nasofrontal flap. The patient was included in the decision and did not wish for reconstruction with the nasofrontal flap as she was not happy with her forehead.
1
The tumor was marked and a surgical margin of 5 mm was drawn.
2
The tumor was excised in 5 mm margin including subdermal slim tissues and marked a 12 o clock for the histologic assessment. The defect was left open and histology showed that the tumor was radically excised.
3
Drawing for the bilateral nasolabial flaps.
4
The patient was not happy with the cosmetic result of her nose. The flaps are very thick leaving her nose with a wide expression. The profile of the nose was quite good. The patient is now in pre-operative planning for surgical thinning of the flap.
