Wednesday, August 02, 2006

Therapeutic Question

The patient is an 83 year-old woman with a two year history of a lesion on the nose.
Clinically, this is a basal cell. My question is what you would recommend as therapy and why?

1) Micrographic surgery with forehead advancement flap.*
2) Micrographic surgery with graft or allowed to heal by secondary intention.
3) Radiotherapy
3) Other

* Repair of defects on nasal sebaceous skin.
Dzubow LM.
Department of Dermatology, University of Pennsylvania Health System, Philadelphia, 19085, USA.
BACKGROUND: Reconstructive procedures performed on sebaceous nasal skin are prone to partial flap necrosis, scar spread and inversion, and tissue mismatch. An ideal repair would optimize vascular integrity, minimize closure tension, and use adjacent tissue. OBJECTIVE: The purpose of this article is to describe a flap design and dynamics that permit satisfactory reconstruction of small- to medium-sized defects on nasal sebaceous tissue. METHODS: A modified advancement flap is described that may be used on central and off-midline defects of the nasal tip. RESULTS: Use of the modified advancement flap resulted in good cosmetic results with few adverse postsurgical events. CONCLUSIONS: The modified advancement flap satisfies the requirements of a hardy blood supply, minimization of closure tension, and use of adjacent tissue. The surgical results are predictable and rarely associated with complications.

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