“Specializing in Reconstructive Plastic Surgery of Skin Cancer”
Board Certified in Plastic Surgery since 1992
Not surprisingly, the nose is the most common location for skin cancers on the face (30-40%). Of these, most of them occur near or at the tip. It is also the most challenging area to repair, because of its complex curves and contours. Skin cancers are always bigger than they first appear, and when they are removed they leave a dent that must be closed in a smooth fashion. This is where plastic surgery principles and techniques are truly demonstrated.
The following case illustrates the repair of an 8mm circular defect near the tip of the nose using a “skin flap”.
This is an excellent example of how a skin flap works. A “flap” means that the skin is lifted and moved over. A flap is a fundamental concept of plastic surgical reconstruction in general. It is called a “bi-lobed” flap because there are two “lobes” lifted to close the defect. The principle is that the front of the nose cannot simply be “stitched up” because it would pull on the nostril distort the tip. However, the skin on the side of the nose has more elasticity and more “give”, and this skin can be lifted and slid over to reach the defect at the tip. The second “lobe” allows for it to reach.
1 – This defect is relatively small, 8mm. The skin near the tip or the nose is not pliable for simple closure without a skin flap.
2 – The skin along the side of the nose will rotate over to reach the defect. It is designed so the skin closes on a line running along the side of the nose, a good place to conceal an incision line. Picture the heart-shaped piece rotating over to the right.
3 – Once the skin on the side of the nose is lifted up and stitched closed, the skin has enough elasticity to rotate over comfortably and reach the defect.
4 – The skin is trimmed to fit exactly. The two circular “lobes” are stitched in place – the perfect color and thickness.
5 – After only 3 months, the skin has healed and it is difficult to find the incision lines, even very close up. It is truly a remarkable concept and design, to borrow skin where it is pliable and bring it to a place where it is not. It is a principle that is a cornerstone of plastic reconstructive surgery on all parts of the body.
The following library of cases demonstrates a variety of skin cancer defects and their repairs. Even though many of these skin defects are daunting, proper surgical principles and techniques allow for Dr. Diehl to provide excellent reconstructions.Back to Top