About Structural Grafts
When a skin cancer is removed from the ear or nose, the remaining defect may be deep enough to involve the cartilage below. Cartilage is the stiff, supporting structure which creates the shape of the outer ear and nose. When a portion of this cartilage is removed, it often needs to be replaced in order for the structure to maintain its previous shape.
When cartilage grafting is required, a donor site is first selected by choosing an area that will remain inconspicuous and has the appropriate shaped cartilage. Cartilage grafts may be harvested from the nasal septal cartilage, ear cartilage, or the costal cartilage of the ribs. If the ear is being repaired, the graft is often taken from behind the ear. If the nose is being reconstructed, the graft would most likely be taken from the nasal septum, which divides the nasal passages. Small pieces of cartilage are taken from the donor site and custom shaped to recreate the missing structure which was removed.The grafts are strategically placed and secured like a framework beneath the skin until the desired supporting structure is achieved.The reconstruction of the overlying skin is then completed.
DISCUSSION This series of large forehead defects features a frequent common theme of reconstruction. The goal of reconstruction is protection of eyebrow position and prevention of upper eyelid retraction. If tension was placed on the eyebrow with a large forehead flap, upper eyelid can suffer from a cicatricial lagophthalmos. Incomplete closure of the eyelid…Read More
HISTORY 61-year-old woman presents with several year history of pigmented left cheek and lower lid lesion. She was initially treated with liquid nitrogen 15 months ago. A biopsy was performed 6-8-17 and revealed melanoma in situ. Excision with close margins performed 6-16-17. Clear margins found on LPMG reading. Second opinion from UCSD was suspicious for…Read More
A middle-age man with previous melanoma-in-situ of the back presents with new chin lesion biopsied as melanoma-in-situ on a deep shave biopsy. Subsequent surgical excision with 2 mm margins revealed no evidence of residual melanoma. Observation was chosen as the course of management. Should additional wider margin resection be performed? Melanoma-in-situ (MIS) is a high…Read More
HISTORY 63 year old woman diagnosed with recurrence of BCC of left upper lip in 2015 after treatment of Efudex and a surgical excision in 2005. Patient had 3 separate BCC locations in left upper lip. Due to the size and multifocality of the lesion, patient was treated with Erivedge for 7 months with a…Read More
HISTORY This 69-year-old man presented with greater than 25-year history of multiple basal cell carcinomas of the face and neck. His most problematic cancer has been in the right face. The right facial basal cell carcinoma story that we were able to uncover started 11 years ago with wide local resection of right ear and…Read More
HISTORY 79 year old man presented in 3/2017 with basal cell carcinoma of the right ear involving the parotid and the tragal cartilage. 3 levels of Mohs were done without clear margins. Mapping biopsies were performed on 3/20/17 showing metatypical basal cell carcinoma with perineural invasion in the parotid but not the facial nerve. On…Read More
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