The 'inverted' advancement and inferior rotation of the nasal sidewall (AIRNS) flap for defects of the medial canthus

Canthal Rotation Flap: Analysis of Flap Mechanics

BACKGROUND

Surgical defects of the medial canthus lack reconstructive options that are reproducible, precise, and uncomplicated. The canthal rotation flap is a simple rotation flap that respects the geometry of this anatomic location.

OBJECTIVE

To describe the authors' experience with reconstructive planning, flap mechanics, and geometric analysis of the medial canthus to achieve the best cosmetic outcome when using the canthal rotation flap.

METHODS

A retrospective review of 16 cases performed at Dayton Skin Care Specialists and Skin Care Specialty Physicians between 2016 and 2018 was completed with a blinded visual analog score (VAS).

RESULTS

Sixteen patients with Mohs defects in the medial canthus were reconstructed using the canthal rotation flap. Defect diameters ranged from 0.8 to 2.7 cm. Patient ages ranged from 17 to 88 years. The mean flap dimensions were 4.8 cm by 2.15 cm. No major complications were noted. The VAS scar rating at 2 to 5 months follow-up was available for 10 of 16 patients; the mean VAS was 2.1.

CONCLUSION

The canthal rotation flap is a reliable, single stage repair for small defects of the medial canthus that is optimized for the unique geometry of the medial canthus. This repair technique adds to the paucity of reconstructive options for the medial canthus.

The Differential Use of Bilobed and Trilobed Transposition Flaps in Cutaneous Nasal Reconstructive Surgery

BACKGROUND

Bilobed and trilobed transposition flaps are versatile random pattern transposition flaps that reliably restore nasal symmetry, topography, light reflex, and contour and are frequently used in cutaneous nasal reconstructive surgery. The authors wish to compare the characteristics of bilobed and trilobed flaps in cutaneous reconstructive surgery and to identify scenarios for their differential use.

METHODS

A retrospective chart review over 7 years of consecutive patients who underwent reconstruction with a bilobed or trilobed flap after Mohs micrographic surgery was performed. Statistical analysis of patient and surgery characteristics, anatomical distribution, postprocedural events, and need for revisions after both flap types was conducted.

RESULTS

One hundred eleven patients with bilobed flaps and 74 patients with trilobed flaps were identified. Bilobed flaps are significantly more frequently used on the inferior nasal dorsum and on the sidewall, whereas trilobed flaps are significantly more frequently used on the nasal tip and infratip. No significant difference in postprocedural events (e.g., complications, erythema, trapdoor) was noted between the two flap types.

CONCLUSIONS

Bilobed and trilobed transposition flaps are versatile means of repair for nasal reconstruction. Trilobed flaps may be used to repair defects in a more distal nasal location than bilobed flaps. Regardless of flap type, complications are rare.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.