Repair of a Combined Nose, Cheek, and Glabellar Defect

Abstract

A 71-year-old man with a history of rheumatoid arthritis and remitted lymphoma presented with a recurrent squamous cell carcinoma. He had previously been treated with Mohs micrographic surgery by another physician who chose to repair the defect with a paramedian forehead flap. The patient reported that a few months after surgery he noted a scaly plaque extending from the flap. This area rapidly expanded to encompass the entire nasal dorsum, nasal root, glabella, and bilateral nasofacial sulci (Figure 1A). After 4 stages of Mohs micrographic surgery, the final defect measured 9.8 3 7.0 cm extending from the mid forehead to the nasal tip with bone exposed from the glabella to the nasal bridge (Figure 1B). How would you reconstruct this defect? Figure 1. Defect after achieving clear margins with Mohs micrographic surgery.

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“…Dr. Bordeaux and his colleague published the techniques used to repair the final defect. 7 Given the history of recurrence after surgery, he stated, "We wanted to act as soon as possible." The patient had 2 pedicles feeding his nose, which reportedly needed to remain in place for 4 to 6 weeks.…”