Nasal tip rotation flaps successfully repair nasal defects from Mohs surgery

Key takeaways:

• After undergoing a nasal tip rotation flip, none of the patients reported any significant post-operative complications.
• No patients required revision surgery following reconstruction.

Nasal tip rotation flaps are reliable solutions for repairing defects on the distal nose following Mohs micrographic surgery, according to a study.

“Mohs micrographic surgery (MMS) is a highly curative and cost-effective treatment for skin malignancies of the nose,” Jace Rickstrew, MD, a Mohs micrographic and reconstructive surgeon at the Heartland Dermatology and Skin Cancer Center, and colleagues wrote. “Reconstruction of surgical defects on the nose following tumor extirpation by MMS can be challenging given the limited tissue reservoir inherent to the nose.”

According to the retrospective review led by Rickstrew, 14% to 17% of all skin cancers occur on the nose, making this a widespread challenge among patients. This challenge is exacerbated when the defect is located on the distal nose, specifically the tip of the nose, soft triangle, nasal rim and nasal ala.

In this study, Rickstrew and colleagues described their experience using a nasal tip rotation flap for 66 cases of MMS defects on the distal nose. Most of the tumors were either nodular basal cell carcinoma, moderately differentiated squamous cell carcinoma or infiltrative basal cell carcinoma with the average tumor size being 0.8 cm and defect size being 1.2 cm.

After undergoing a nasal tip rotation flap, none of the patients reported any significant post-operative complications. Three patients had smaller contour irregularities along the healing incision line, and two reported slight alar notching. However, none of these patients required revision surgery.

Two patients underwent dermabrasion to improve their esthetic outcomes and one underwent intralesional triamcinolone for a hypertrophic scar. No patients expressed the need for laser resurfacing.

“Although there is inherent complexity in repairing defects of the distal nose, we have found the [nasal tip rotation flap] to reliably produce exceptional functional and cosmetic outcomes,” the authors concluded. “This flap can successfully be utilized by dermatologic surgeons for reliable reconstruction of defects.”