Authors: Hasan Gökcer Tekin, MD, Frederik Gulmark Hansen, med.stud., and Magnus Balslev Avnstorp, MD

Patient history

A 80 years old woman presented a SCC on the nasal dorsum measuring approximately 15mm. She had a large tumor which was resected with 7mm margin on the proximal half of the nose. The patient had an active lifestyle and the cosmetic result was very important to her. Reconstruction with a rhombic transposition flap from the glabella region was planned.

Before and after

Analyzing the case

The defect was located on the proximal half of the nose slightly off-center, involving the multiple aesthetic subunits of the nose (dorsum and both sidewalls). There was a lot of lax skin in the patient’s glabella and had similar texture and color to that of the defect. The secondary defect could be closed in the RSTLs of the glabella.

Step 1: Pre operative drawing

The turmor is marked with a 5 mm. safety margin around it for excision.

Step 2: Excision

Tumor was excised including a 5 mm. safety margin.

Step 3: Flap drawing

The flap was designed with the scar placed vertical in the RSTL of the glabella.

Step 4: Raising the flap

The skin was incised with a #15 blade and the undermined in the subcutaneous plane under the flap and down towards the left medial canthus to make the rotation easier.

Local flaps from the glabella can be risen in the subcutaneous plane, compared with flaps from the nasal dorsum which require subnasalis muscle dissection.

Step 5: Flap rotation

The rhombic transposition flap from the glabella was rotated 90 degrees into the defect, and the distal half of the flap including the tip was trimmed for all subcutaneous fatty tissue.

Step 6: Closure

The flap and the secondary defect were sutured with interrupted Vicryl 5-0 and continuous Nylon 5-0 sutures.

Step 7: Immediate result

Post-operative photo taken immediately after surgery

Step 8: 2-Week follow-up

The flap had a good color and texture match with surrounding skin. Minimal pincushioning was seen at the wound edges.

Post-Operative Care

Stiches removed after 7 days.
Paracetamol and NSAIDs for pain management

Follow-up after 2 weeks