Plastic and Thoracic Surgery, Orthopedics and Ophthalmology by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030107109
Publisher: Springer International Publishing

6 Nose

The nasal cartilages are soft and malleable. Therefore, when removing lesions of the nose over the cartilages, care must be taken not to have any tension in the closure. Skin grafts should be made slightly larger than the defect to prevent contraction that will cause deformation by buckling of the cartilages.

A case of removal of a basal cell carcinoma with skin graft coverage on the dome of the nose was complicated by incomplete removal of the cancer. The pathologist suggested re-excision of the residual tumor. The skin (2 mm) around the graft was removed and the defect sutures closed. This resulted in buckling of the underlying cartilage (Fig. 5). Another case had resection of a basal cell carcinoma over the right lateral cartilage. A composite graft after resection was placed but ultimately failed. The pathologist said there was residual carcinoma (the author did not think there was residual because the pathologist was not informed that the two portions of the cancer were actually one circular excision but not properly marked by the nurse after surgery). The patient had a dermatologic surgeon perform Mohs surgery and no cancer was found. The wound was allowed to heal by secondary intention and is now virtually invisible (Fig. 6).

Fig. 5Buckling of the dome cartilage because of tension. Small arrow shows protruding cartilage and long arrow shows graft with depression

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