Abstract
Introduction
For nasal tip reconstruction, we must consider optimal results including color match, good tissue coverage, excellent flap viability, and good aesthetic result.
Methods
In this study, 25 patients who had nasal tip skin tumors were included, and reconstruction of the defects by dorsal nasal advancement flap (Rintala) was done. The advantages and disadvantages of the Rintala flap were described for all patients with nasal tip basal cell carcinoma (BCC). All patients filled out the consent form before reconstruction and tumor surgery.
Results
In this study, 25 patients (11 women and 14 men) ranging from 25 to 72 years old (mean, 53 years) underwent operation with dorsal nasal advancement flap (Rintala). Reconstruction of nasal tip defects after complete tumor excision was done with free margin. After sedation analgesia, we used bilateral parallel incision in both sides of the nasal sidewalls from corner to glabellar region; Burow triangles are excised bilaterally in lateral to the base of the flap.
Conclusions
In case of midline tip defects with 1.5 to 2.5 cm in diameter, a modified Rintala flap is a good choice for reconstruction of this difficult area. This is a superiority-based randomized flap that makes an aesthetic nasal tip after tumor excisions without any fear from ischemia or necrosis of the flap.
1
Introduction
There are several options for nasal tip reconstruction after nasal skin tumor surgery. For nasal tip reconstruction, we must consider optimal result including color match, good tissue coverage, excellent flap viability, and good aesthetic result .
This advancement in dorsal nasal flap that is described by Rintala is a random nasal flap that was done in a single stage easily; furthermore, it leaves the scars in areas of natural shadow. Aesthetic results are acceptable, and it does not have morbidity of forehead donor site. Although this is a random pattern dorsal advancement flap, it has low risk of ischemia in distal part of flap. This flap is suitable for nasal tip skin defects after basal cell carcinoma (BCC) excision. It has the advantage of providing the most similar type of skin to resurface the nasal tip .
2
Patients and methods
This was a prospective case series study that was done in the plastic surgery ward in Baqiyatallah Hospital in Tehran between 2009 and 2011. The advantages and disadvantages of Rintala flap were described for all patients with nasal tip BCC. All patients filled out the consent form before reconstruction and tumor surgery. We considered patient’s wishes before choosing a reconstructive technique.
This study was approved by the ethics committee in Baqiyatallah Hospital. In this study, 25 patients (11 women and 14 men) ranging from 25 to 72 years (mean, 53 years) underwent surgical excision of tumors with safe margins and reconstructions with dorsal nasal advancement flap (Rintala). Reconstruction of nasal tip defects after complete tumor excision with free margin was done. We considered 4- to 6-mm margin for BCC and 6- to 10-mm for squamous cell carcinoma (SCC) of the nasal tip; all specimens were sent for frozen section, and safety margin was subsequently confirmed. We reported 21 BCCs and 4 SCCs. All patients after tumor excision had intact nasal cartilage framework. After sedation analgesia, we used bilateral parallel incision in both sides of the nasal sidewalls ( Fig. 1 ) from corner of the defect to glabellar region to allow sufficient advancement; Burow triangles are excised bilaterally in lateral to the base of flap ( Fig. 2 ).
We must advance the flap to close the defect without any tension. The flap was elevated in supraperiosteal plan; this is important to preserve blood supply and to prevent tissue ischemia. We also designed the flap longitudinally from the corner of defects. This modification was important because of prevention of pincushion. We chose this flap for median nasal supratip and tip defects with a diameter larger than 1.5 cm. For large defects, we used another local flap. After releasing and advancement of flap, repair must be done in 2 layers (subcutaneous and skin); this is important for prevention of wide scar and pincushion; in addition, we did not use lateral flap incision in the nasal-cheek junction because of probable swelling and flap pincushion.
2
Patients and methods
This was a prospective case series study that was done in the plastic surgery ward in Baqiyatallah Hospital in Tehran between 2009 and 2011. The advantages and disadvantages of Rintala flap were described for all patients with nasal tip BCC. All patients filled out the consent form before reconstruction and tumor surgery. We considered patient’s wishes before choosing a reconstructive technique.
This study was approved by the ethics committee in Baqiyatallah Hospital. In this study, 25 patients (11 women and 14 men) ranging from 25 to 72 years (mean, 53 years) underwent surgical excision of tumors with safe margins and reconstructions with dorsal nasal advancement flap (Rintala). Reconstruction of nasal tip defects after complete tumor excision with free margin was done. We considered 4- to 6-mm margin for BCC and 6- to 10-mm for squamous cell carcinoma (SCC) of the nasal tip; all specimens were sent for frozen section, and safety margin was subsequently confirmed. We reported 21 BCCs and 4 SCCs. All patients after tumor excision had intact nasal cartilage framework. After sedation analgesia, we used bilateral parallel incision in both sides of the nasal sidewalls ( Fig. 1 ) from corner of the defect to glabellar region to allow sufficient advancement; Burow triangles are excised bilaterally in lateral to the base of flap ( Fig. 2 ).
