05/11/2024
In honor of May as month, here is an illustration of a tricky skin cancer defect repair of the nostril with an absent nostril rim, and missing both external skin and internal nasal lining.
I always tell my patients that the nose is one of the most challenging spots to repair a skin cancer defect: We have limited tissue laxity, meaning we can’t easily borrow skin from the surrounding areas, and the 3-dimensional structure of the nose poses a challenge in that it can easily become distorted from scarring, which is not only not a good look, but can also affect nasal breathing.
Here is an example of a reconstruction of the 3 layers of the nostril: internal nasal mucosa via a wound matrix dressing that helps stimulate regrowth of the nasal lining, ear cartilage for structural support, and skin via a pedicled melolabial flap. The latter is a 2 stage repair procedure, where the skin from the corner of the mouth is swung up to cover the defect, but since it would not survive without its own blood supply, it has a “pedicle” or an attachment to the cheek that remains in place for about 3 weeks.
You can think of the pedicle as an umbilical cord of sorts, that provides the blood supply and nutrients to the new skin covering on the nose. Once it has healed with the surrounding nasal skin, the pedicle can be divided, and it’ll look like a nostril again. Swelling and redness of scars are the norm and over time, all scars look better. Particularly the incision in the cheek fold is well camouflaged and while often a great initial concern by patients, actually heals very nicely.
A heartfelt thank you to this beautiful and strong patient for letting me share her story! As I say, “the reconstruction is going to be a process, but we’ll get there in the end!”
Daniela Burchhardt, MD
Double Board-Certified Facial Plastic Surgeon
drdanielaburchhardt.com | info@drdanielaburchhardt.com
Seeing patients at The Woodruff Institute for Dermatology:
239-307-4605
