Reconstructive Techniques
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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Mitoses in a Dysplastic Nevus
HISTORY 61-year-old man presents with 6-month history of forehead lesion. Biopsy on October 2017 showed atypical nevomelanocytic neoplasm with several mitoses (3/mm2). An excision with 5 mm margins was performed in November 2017 with negative findings. DISCUSSION This melanocytic tumor of uncertain malignant potential can also be called a MELTUMP. These lesions present a treatment…
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Cerclage Closures
DISCUSSION Cerclage closure is a relatively straightforward approach to wound repair in certain locations. Body regions with no appreciable skin creases or relaxed skin tension lines are good candidates for this technique. Regions with inherently high tension of closure is all directions, such central chest and convex shoulder, heal better with a cerclage scar versus…
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BCC Left Upper Lip
HISTORY 87-year-old man presents with 1 year history of lesion on left upper lip. Biopsy taken 11-16-2017 and pathology showed basal cell carcinoma. Mohs excision and reconstruction were performed on 1-19-18. Mohs slide histology was presented for review. A question of appearance of perineural invasion was discussed. DISCUSSION The Mohs slides…
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Recurrent SCC of Nasal Tip
HISTORY 71-year-old man presents with recurrence of SCC of left nose. Mohs excision of left nasal tip SCC was performed on 2-9-17. Left nasal fullness under flap, initially thought to be a scar, progressed until drainage appeared. Pathology of draining debris under flap showed invasive squamous cell carcinoma. Intranasal mapping biopsies were performed on 2-12-18.…
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Reconstructive Cases – Medial Canthal Nose / Eyelid Reconstruction
Scalp Reconstruction 4
Patient diagnosed with Atypical fibrohistiocytic tumor of the left frontal scalp. Reconstruction performed by Dr. Simon Madorsky at SCARS Center.
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Scalp Reconstruction 3
Patient diagnosed with malignant melanoma of midline forehead. Mohs excision performed by primary dermatologist. Forehead/scalp reconstruction performed by Dr. Simon Madorsky at SCARS Center.
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