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Reconstructive Techniques

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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Recurrent SCC of Nasal Tip

HISTORY 71-year-old man presents with recurrence of SCC of nose following Mohs excision on 2-9-17. Partial rhinectomy was performed with incomplete Mohs excision leaving residual positive margins due to patient’s comfort.  Two additional excisions of involved margins were done under anesthesia achieving clear margins. First stage reconstruction was performed on 4-11-18. DISCUSSION Management of a…

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Lower Lip Mucosal Defect

DISCUSSION The goals of lower lip mucosal defect reconstruction include the following: Preservation of vermillion line continuity Avoiding depressions of red lip and preserving lip fullness Preservation of red lip roll (ridge) Myomucosal island flaps help achieve all of these goals. The flaps are created laterally or medially to the defect. The island can be…

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