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Reconstructive Techniques

Delayed Laceration Repair

Traditional approach to laceration repair dictates closure of laceration as soon as possible after an injury. Usually this involves closing the wound with stitches, staples, or skin glue within the first 24 hours.  This timeline can make it difficult for the treating provider to distinguish between viable and irreversibly damaged tissue. This is particularly true…

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Superior Extended Nasal Myocutaneous Island Flap: An Alternative to Forehead Flap Reconstruction of the Nose

SCARS Center has published a scientific article in Facial Plastic Surgery and Aesthetic Medicine, formerly known as JAMA Facial Plastic Surgery, the official journal of the American Academy of Facial Plastic and Reconstructive Surgery. This article introduces an innovative approach for reconstruction of medium to large nasal defects. Medium and large nasal defects are mostly…

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Nasal Open Wound Complication

HISTORY A 73-year-old man with BCC of the nasal tip presented 1 week following Mohs excision. His reconstruction was delayed for an additional week for a cardiac work up. Nasal reconstruction was performed with a superior extended nasal myocutaneous flap (SENMI flap) and nasal septal cartilage grafts. The patient developed nasal tip incisional discharge 1…

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Nasal Skin Graft Revision with Flaps

HISTORY The patient presented for scar revision 8 months after Mohs excision of BCC of the nose and closure with an ear skin graft, performed elsewhere. Patient presents for correction of the atrophic erythematous skin graft scar. The patient was treated with two signature flaps of the SCARS Center developed for nasal reconstruction. DISCUSSION The…

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Leiomyosarcoma of Scalp

HISTORY An 84-year-old man presented with a 7-month history of 2.5 cm ulcerated nodule of the scalp. Biopsy showed a poorly defined neoplasm consistent with a leiomyosarcoma. Wide local resection with 1 cm margins cleared the tumor. The 5 cm scalp defect was reconstructed with multiple large scalp rotation flaps. DISCUSSION Spindle cell neoplasms of…

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Recurrent BCC of the External Ear After Radiation

HISTORY A 77-year-old man presents with 5-year history of infiltrative basal cell carcinoma (BCC) of the left ear fossa triangularis and root of helix. The area was originally treated with four weeks of radiation in 2014, complicated by temporary ulceration and healing with adhesion. When the area developed crusting a couple of years later, the…

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Subtotal Ear Reconstruction with Alloplast

DISCUSSION Subtotal ear reconstruction is a challenging surgical task that often requires non-traditional techniques. This particular patient was treated with an alloplastic implant and rib cartilage grafts. We utilized Medpor Helical Rim implant, a porous polyethylene material (Stryker, USA) used for microtia reconstruction. The implant was used for its elegantly curved helix. The rib cartilage…

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total-ear-reconstruction-with-osseointegrated-prosthesis-skin cancer-orange-county

Total Ear Reconstruction with Osseointegrated Prosthesis

DISCUSSION Total ear reconstruction after radical skin cancer resection can be treated with prosthetic rehabilitation. Optimally, osseointegrated fixation of a prosthesis is employed. This patient was treated with complete ear amputation and post-operative radiation. His prosthetic rehabilitation was a team effort between Simon Madorsky, M.D., at SCARS Center and Mark George, D.D.S., a prosthodontist. Three…

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Management of Recurrent Large Melanoma In Situ

HISTORY 78-year-old man presents with a recurrent melanoma in situ of left cheek in April 2018. Previously, the melanoma in situ was excised in 2001. Patient’s dermatologists performed excision in three stages over a period of 3 weeks to achieve clear margins.  Reconstruction of left cheek was performed with a cheek and neck platysma myocutaneous…

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Reconstructive Cases – Bilevel Grafts

DISCUSSION Nasal ala skin defects can be reconstructed with skin grafts generally with excellent results. However, deeper defects of the nasal ala repaired with a skin graft may result in a depressed deformity. Contraction of skin graft healing may also cause retraction of the nasal ala, especially with deeper defects. Adding a cartilage graft  to…

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