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Reconstruction of nasal skin defects following excision of basal cell carcinoma

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Author(s): Al-Bdour Mohammed | Al-Khateeb Maher

Journal: Our Dermatology Online
ISSN 2081-9390

Volume: 2;
Issue: 3;
Start page: 125;
Date: 2011;
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Keywords: basal cell carcinoma | nasal reconstruction | full thickness skin grafts | local flaps

ABSTRACT
Objective: To present our experience in reconstruction of nasal defects following excision of nasal basal cell carcinoma.Patients and Methods: Retrospective analysis of 36 patients who underwent surgical excision with reconstruction of nasal BCC over the period from March 2009 to December 2010 was performed. After full history and physical examination the diagnosis of nasal BCC was done clinically and confirmed by the final histopathology report, pre and post-operative photographs were taken. The surgery was done in both inpatient and outpatient settings under local or general anesthesia depending on each individual case circumstance: age, co morbidity, size of the lesion and reconstructive option used. After planning of reconstruction surgical excision was done, with immediate reconstruction done in 30 patients and late reconstruction in 6 patients. Our reconstructive options included: primary closure in 3 patients, full thickness skin grafts harvested from pre-auricular area in 13 patients, local and loco regional flaps in 20 patients. Local and loco regional flaps included: forehead flap in 3 patients, nasolabial flap in 6 patients, glabellar flap in 4 patients, V-Y advancement flap in 2 patients, bilobed flap in 3 patients and dorsal nasal flap in 2 patients.Results: Nasal BCC in our study was more common in males 58.3 %( 21 patients) compared to females 41.7 %( 15 patients). The most common presentation was asymptomatic lesion 55.5% (20 patients), other presentations includes itching, local ulceration and bleeding.The most common nasal subunit affected by BCC was the ala 36.1%, followed by tip25%, sidewalls 22.3%, and dorsum 16.6%.The most common histopathological type of nasal BCC was the nodular BCC 55.5% followed by the sclerosing 22.2%, superficial 8.4%, basosquamous 8.4% and pigmented 5.5%.Complications included: hematoma in two cases, incomplete excision in two cases, and partial skin necrosis in one case.Results: Surgical excision with immediate well planned reconstruction performed in selected patients is the best option for management of nasal BCC, with local and loco regional flaps are superior to skin grafts in providing aesthetic subunit restoration of nose.
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