POSTOPERATIVE
DIAGNOSIS: Acquired nasal deformity, status post Mohs
surgery.
OPERATION
PERFORMED: Reconstruction of acquired nasal deformity
with rotation advancement flap approximately 2 x 1.5 cm.
ANESTHESIA: Lidocaine 0.5% lidocaine with epinephrine plus
Neut.
COMPLICATIONS: None.
INDICATIONS:
This patient is a
72-year-old white female with a history of skin cancers who recently underwent
a biopsy of a lesion on the left side of her nose. She was advised to have Mohs surgery and was
seen in my office for a preoperative consultation in regards to post Mohs
reconstruction. A full consultation was
provided to the patient in the office discussing options for reconstruction
including, but not limited to healing by secondary intention, skin graft
reconstruction, and local flap reconstruction. The pros and cons were thoroughly discussed
with her as well as potential risks and complications, which include, but are
not limited to bleeding, infection, scarring, asymmetry, deformity, recurrence,
problems with healing, hypo or hyperpigmentation, hypertrophic or keloid
scarring, widening of the scar, donor site morbidity, and scarring, and the
need for further surgery. She is fully
informed that there will be scars. Scars
are permanent, and no guarantees can be given as to the final outcome,
appearance, location, or length of the scar. The patient states she understands. All of her questions were answered and she
gives consent.
PROCEDURE
IN DETAIL: The patient taken to the operating
room, placed in a supine position where the area was prepped and draped using
sterile technique. The patient had
approximately 1.2-cm defect of the left nasal sidewall. Primary closure was not possible and therefore
a rotation advancement flap was designed measuring about 2 x 1.5 cm in size. This was drawn along least tension lines and
natural skin creases wherever possible, and the area was infiltrated with 0.5%
lidocaine with epinephrine plus Neut.
A 15 blade was
used to incise the flap through skin and subcutaneous tissue, elevating the
flap off the underlying deeper tissue. Undermining
was performed along the donor site. Flap
was elevated and rotated, a small dog ear was excised, and meticulous
hemostasis was achieved. Gelfoam was
used to secure the hemostasis.
The flap was inset
using multiple interrupted buried 5-0 Vicryl sutures to approximate the
subcutaneous tissue and dermis followed by 5-0 Prolene in a running fashion. Total defect reconstruction was 2 x 1.5
cm. Mastisol and Steri-Strips were
applied as a dressing. The patient
tolerated the procedure well.
The patient was given written and verbal instructions in regards to wound
care, signs and symptoms of infection, and followup. The patient was informed to call if she has
any questions or problems.
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