Paver T/F Flashcards
Risks associated with side to side closure on nose is blunting of the nasal root concavity
T
Second intention best in deep defects and concave areas
F, shallow defects and concave areas eg. Alar crease
Main disadvantage of second intention is need for wound care and long healing time over approximately 6 weeks
T q
When defects located in two adjacent cosmetic subunits, consider closing each subunit as a separate defect
T
Full thickness skin graft from conceal bowl may be a good match for sebaceous tip nasal skin
T, although closure of donor site can be problematic
Glabella and nasolabial fold are other donor site options for a better tissue match on sebaceous nose skin
T
Nasal side to side closure can be performed for defects 10mm and under
F, 8mm
Side to side nasal tip closure can elevate soft triangles and alar rims
T - this leads to flaring nostrils
Bilobed flap can close defects less than 2cm diameter
F, 1.5cm
Bilobed flap - scar will be lower on nose than original lesion
F, higher
Bilobed flap - Reduced airflow can occur due to buckling effect of alar cartilage and mucosa
T
Dorsal nasal rotation flap for defects up to 2cm in diameter
T
How to perform a myocutaneous island pedicle flap
- Design a thin triangle on the dorsum of nose extending up from the superior edge of the defect to the dorsal crease (at the nasal bridge)
- First incision down lateral edge , extending into SC fat only. Ensure muscle remains intact. Undermine skin lateral to the flap in the SC fat layer just beyond the Nasofacial sulcus. Need to extend this undermining down to the lateral aspect of defect to create a pocket for the muscle pedicle
- After haemostasis, incise the medial edge of the flap down to cartilage and nasal bone
- Undermine the flap beneath nasalis down the sidewall of the nose to the nasofacial sulcus, mobilising the triangular skin flap on its pedicle
- Mobilise flap further by making horizontal cuts along the muscle pedicle (not always required)
- Place first absorbable suture to pull flap across defect.
- Place remaining absorbable sutures using rule of halves
- Insert superficial sutures - consider using a superficial horizontal mattress suture to help with eversion
- Place a tip stitch at the triangle’s superior corner to ensure appropriate tip placement
Subcutaneous island pedicle flap maintains nasal symmetry
T
Two stage paramedian forehead interpolation flap may produce a flat nose tip
F - bulbous nose tip
