Stahly Samuel, Dunn Charles, Faraj Yasser, Dane Alexander
Dermatology, Kansas City University Graduate Medical Education (KCU-GME) Consortium and Advanced Dermatology and Cosmetic Surgery (ADCS) Orlando, Orlando, USA.
Cureus. 2025 Apr 29;17(4):e83188. doi: 10.7759/cureus.83188. eCollection 2025 Apr.
A 66-year-old female active smoker with a history of nonmelanoma skin cancer underwent Mohs micrographic surgery for a basal cell carcinoma located at the junction of the superior nasal sidewall and medial canthus. The cancer was completely excised in two stages of Mohs surgery; however, the resulting surgical defect, measuring 1.5 x 1.6 cm, posed a challenging reconstruction. Several factors contributed to the complexity of the repair, including the lesion's large size, involvement of multiple cosmetic subunits, proximity to the free margin of the eye, and the patient's smoking status. Common Mohs surgery repair techniques include direct approximation, secondary intention healing, advancement or rotational flaps, and full-thickness skin grafts. Each case requires an individualized approach, considering its unique characteristics. In this instance, a novel variation of an advancement flap was developed. An advancement flap is a surgical technique that moves adjacent tissue over a defect linearly. The island pedicle, a type of advancement flap, remains attached to its underlying blood supply to enhance survival. This technique relies on subcutaneous fat, limiting its use. A myocutaneous V-to-Y flap is a variant utilizing the vascular supply of an underlying muscle, making it suitable for areas with minimal subcutaneous tissue. The nasalis sling, commonly used for distal nose defects, exemplifies this approach. We report a novel myocutaneous V-to-Y flap variant using the glabellar musculature to repair a defect in the superior nasal sidewall and medial canthus. This technique demonstrates reliability in active smokers, leveraging the vascular supply of underlying muscles for improved survival. Additionally, it offers a superior tissue and texture match, as it uses adjacent tissue. This report aims to assist surgeons facing similar reconstructive challenges, as this technique yielded an excellent cosmetic outcome in our patient.
一名66岁有非黑色素瘤皮肤癌病史的吸烟女性，因位于鼻上侧壁与内眦交界处的基底细胞癌接受了莫氏显微外科手术。该癌症在莫氏手术的两个阶段中被完全切除；然而，由此产生的1.5×1.6厘米的手术缺损给修复带来了挑战。修复的复杂性由几个因素导致，包括病变尺寸大、涉及多个美容亚单位、靠近眼部游离缘以及患者的吸烟状态。常见的莫氏手术修复技术包括直接拉拢缝合、二期愈合、推进或旋转皮瓣以及全厚皮片移植。每个病例都需要根据其独特特征采用个体化方法。在这种情况下，开发了一种推进皮瓣的新颖变体。推进皮瓣是一种将相邻组织沿直线移动覆盖缺损的外科技术。岛状蒂皮瓣是推进皮瓣的一种类型，仍与其下方的血供相连以提高存活率。该技术依赖皮下脂肪，限制了其应用。肌皮V - Y皮瓣是一种利用下方肌肉血供的变体，适用于皮下组织最少的区域。常用于鼻尖远端缺损的鼻肌吊带就是这种方法的例证。我们报告一种使用眉间肌肉组织修复鼻上侧壁和内眦缺损的新型肌皮V - Y皮瓣变体。该技术在吸烟患者中显示出可靠性，利用下方肌肉的血供提高存活率。此外，由于使用相邻组织，它提供了更好的组织和质地匹配。本报告旨在帮助面临类似重建挑战的外科医生，因为该技术在我们的患者中产生了出色的美容效果。
