Dorsal Nasal Flap – Post Mohs Surgery: Part II

Following on from Dorsal Nasal Flap - Post Mohs Surgery: Part I this pictorial documents my recent:

1. Two stages of Mohs surgery to remove nasal basal cell carcinomas

2. Dorsal nasal flap for nasal reconstruction

3. Dressing removal post-surgery

Mohs surgery involves the removal of skin cancers with a high degree of precision and minimal loss of normal tissue under microscopic control. First developed by Dr Frederic Mohs in the 1930s, it has undergone a vast improvement since then and is now reported to be an effective way of removing skin cancers in cosmetically sensitive areas such as the face and nose.

As with my previous Mohs surgeries there was no prior fasting for a procedure that would see me in the operating room at 8.00am and heading for home at 1.30pm.

Marked area contains nasal basal cell carcinomas

First Stage: While in the operating room my nose was made pain free with an injection of a local anesthetic. Once the visible portion of the skin cancers were removed by scraping, the Mohs surgeon excised a thin circular horizontal layer of nasal tissue (see fig 2) containing a:

1. Multifocal basal cell carcinoma (BCC)

2. Micronodular BCC

3. Small margin of healthy looking skin

On the completion of the first stage a dressing was applied to my nose and I was returned to the recovery room. There I waited for the excised nasal tissue to be prepared and microscopically examined. Unfortunately the results revealed that the cancers had not been completely removed.

Second Stage: I was returned to the operating room where the surgeon removed a layer of nasal tissue from the same area. As the results revealed the tumors had been completely removed on this occasion there was no need for further stages of Mohs surgery.

Post-Mohs nasal defect (fig 2)

It was now time to reconstruct my nose using a dorsal nasal flap. Using the image above to explain the procedure:

1. An incision was made along the outer blue line

2. Skin and underlying tissue bounded by the incision line freed to form a flap

3. Freed tissue rotated down into the defect

4. Wedge shaped wound skin edges above the nose drawn together

5. Fine suturing to hold the skin in place (see fig 3)

For those more technically minded, the online PDF article “The Dorsal Nasal Flap for Reconstruction of Large Nasal Tip Defects” by Dr Marc S. Zimbler, MD, FACS, explains the dorsal nasal flap procedure far better than I could ever give.

Nose three days post-dorsal nasal flap (fig 3)

Returned to the recovery room with a dressing on my nose I was discharged in the company of my wife a short time later.

Part of the post-operative instructions included removing the dressing three days later, and as you can see from the image above my nose looks well and truly on the road to recovery.

Related and Previous Mohs Surgery Articles:
Aldara Skin Cancer Treatment	Dorsal Nasal Flap - Post Mohs Surgery: Part I	Skin Cancer Nose No Boundaries	Skin Cancer Nose No Boundaries - Part II
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