BEFORE AND AFTER
A large full thickness defect of the nose and adjacent cheek and upper lip followed excision of a large skin cancer. The majority of the nasal bridge and septum was absent. His nose was repaired with two simultaneous forehead flaps in 3 stages to supply cover and lining for the nose. Rib grafts supported and shaped the repair. The cheek and lip were reconstructed with lip and cheek advancement flaps and a fat graft. The scars within the forehead, nose, cheek, and lip are minimally visible, postoperatively.
Skin over most of the nose was removed to treat skin cancer. His underlying tip cartilages and small amounts of lining along each nostril were missing. To better position scars and improve contour, additional skin was excised to permit the reconstruction of the nasal subunit. This would avoid a patched appearance after repair. The nose was reconstructed with a full-thickness 3 stage forehead flap for covering skin and lining and ear cartilage grafts for nasal support. This defect was repaired with the Modified Folding Lining Technique, developed by Dr. Menick, as part of his 3 stage forehead flap approach.
Injured at birth, multiple attempts at nasal reconstruction with a prior forehead flap, nasolabial flaps, cranial bone grafts, and ear cartilage grafts had failed elsewhere. Her forehead and cheeks were scarred by previous surgery. Reconstruction was performed with an expanded forehead flap, local hingeover lining flaps and rib cartilage support. She looks normal for the first time in her life. She breathes well.
This patient has a composite defect. After skin cancer excision, the wound encompassed multiple facial units. He is missing parts of the nose, adjacent cheek and lip. He also has a full thickness defect of the right ala and sidewall. Adjacent skin and underlying fat within the cheek and lip are also missing. First, the cheek and lip defects were repaired with a cheek flap and fat flip flap. Then the nose was built on a stable facial platform, in the correct position. The nose was repaired with a 3 stage forehead flap , folded for lining, and ear cartilage support grafts. This defect was repaired with a Modified Folding Lining Technique, developed by Dr. Menick, as part of his 3 stage forehead flap approach. The delicate anatomy of the nose, cheek, and lip is restored. Scars are virtually invisible because they lie hidden in the expected shadow lines of the face. Most importantly, the contour of the nose, lip, and cheek is normal.