facial plastic and reconstructive surgery in Winston Salem North carolina
Skin Cancer Repair Procedure Overview
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Skin Cancer Patient :
carcinoma of her lip and her nose. The cancer spread not only across most of her upper lip but also up into her nose, onto her nostril, and into the floor if her nose. In order to fix a defect like this, we need to think of a few things. The first is that the lips must maintain the integrity of the muscles, which will allow us to close our mouths, to speak and to eat, as well as express emotions. We need to create flaps to close this, still preserving the shape of the nose and the airway. To repair this we use large flaps that come from the cheek and from the lip to repair the lip and actually replace the whole lip with a new area of skin from the cheek. To fix the nose we use cartilage and skin grafts. |
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Skin Cancer Patient:
The nose is a very common site of basal cell carcinoma. One of the problems with most repairs, particularly of the nostril rim, is that nostrils look notched. Many surgeons repair this area with just a simple skin graft or without any cartilage grafting. In order to replace a large defect and get the best chance for not having notching, we need to replace three layers, not just skin. It takes us two surgeries but we replace inner lining or mucosa, usually from inside the nose. We replace skin on the outside of the nose, usually from the nose or from the cheek, and for structure we replace the missing cartilage with cartilage. It is this approach that allows us to have reconstructions that will withstand the test of time and avoid scar contracture and asymmetry as much as possible. |
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Skin Cancer Patient:
For some nasal reconstructions we use a two-stage procedure called a pedicled melolabial flap. In this case we take a flap of tissue that comes from the cheek. The cheek tissue is sutured to the nostril but not disconnected from the cheek for three weeks to let blood vessels grow in from all sides. We also place a cartilage graft from the ear to avoid the common complication from nasal reconstruction, which is notching and asymmetry of the ala margin. After three weeks of letting blood come from its original source and new blood vessels grow from the sides we can cut the pedicle and make the new nostril bigger. As you can see here we replaced her whole nostril on the left side and that makes it appear much more natural than replacing just a piece of her nostril or a piece of her nostril and a piece of the side of her nose. It is important to have cartilage grating as well to help preserve the airway itself. |
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Skin Cancer Patient :
The hardest part of reconstructing a nose is inner lining for nasal reconstruction. As you can see, this patient has a hole in his nose that not only involves the skin but also the structure (cartilage), as well as the lining of the nose (mucosa). He is also missing tissue along the floor of his nose. If we don't reconstruct the floor of his nose, his nostril will scar down and he will not be able to breathe. If we don’t replace the structure to his nose his nostril will collapse (nasal valve collapse) and it will make his nose look asymmetric. There is much more to nasal reconstruction than just filling in a hole with skin.
In this case we have reconstructed the floor of his nose with a graft, as well as the nostril, with a graft that will help shape the nostril and maintain his airway. Notice also the large lip defect, which was reconstructed and allows closure resulting in a line that leaves only a vertical scar similar to most wrinkles on the lips so it is more difficult to see. |
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