75-year-old man presents with a history of recurrent basal cell carcinoma of the nasal tip, previously treated with liquid nitrogen and excised 3-5 years ago. Mohs surgery was performed 7-10-2017 with a 3.2 x 3 cm defect extending from the nasal tip and ala to the mid dorsum. Reconstruction was performed with an extended superior nasal myocutaneous island flap and extended right lateral nasal myocutaneous island flap.
This case represents extensive release of a flap with tension. The extensive release limited the blood supply of the extended superior nasal myocutaneous island flap. The tension further put the blood supply under stress causing ischemia of the leading edge. Despite the ischemia, the patient is healing well. Only the superficial dermis was compromised. The deeper muscle bed blood supply appeared to have remained intact