The cosmetic results of the new single procedure are almost as good as with the double procedure.
New nasal reconstruction technique skips second procedure
issue 18 | spring/summer 2013
The basal cell carcinoma growing on Carolyn Bohlmann's nose was not aggressive, but it was deep and located right on her nostril. The tricky part was not the MOHS surgery to remove it, but reconstructing her nostril to good results, both cosmetically and functionally.
Bohlmann opted for a new reconstruction technique her surgeon, Jeffrey Moyer, M.D., was offering at the University of Michigan Comprehensive Cancer Center. Moyer removed cartilage from behind Bohlmann's ear, and skin from her shoulder, and shaped it to create a new nostril.
"It healed up nicely. You can see a bit of a wrinkle, sort of a raised wrinkle. No one notices it unless I say something about having a surgery," says Bohlmann, 69. Ten days after having the procedure done, she was back to work.
A ONE-TWO PUNCH
"The nose is a fairly complicated area to reconstruct," says Moyer, an associate professor of otolaryngology at the U-M Medical School.
The most common method for nasal alar reconstruction uses ear cartilage to reshape the nostril and forehead or cheek skin to create a skin flap that provides a blood supply. The flap stays in place for about three weeks, after which patients come back to have it removed. Typical results look good, and the nostril functions correctly.
Before and After
A SINGLE SURGERY
But what about patients who can't — or don't want to — endure two procedures? Moyer and his team started with one key question: Do we really need that blood supply from the skin flap?
The new procedure skips the skin flap — and the need for a second procedure—but still appears to allow for the cartilage to take hold and keep its place without the nostril either collapsing or pulling up. On a one-to-five scale, with one meaning excellent, the average cosmetic result was judged a 2.3.
"This could save both patients and surgeons a lot of effort and time. The last thing people want to do is return to the OR," Moyer says. "It allows us to spare people multiple surgeries or a scar that dominates the cheek."
Moyer says that the cheek flap technique has a somewhat better cosmetic result than his new procedure. But since many skin cancer patients are older, their co-morbidities may make that second procedure inadvisable.
"The incremental benefit with a cheek flap is not worth it for some patients. The ability to do something less but still get the same quality of results is important," he says.