New reconstructive procedure repairs nose after skin cancer in just one step

A new reconstruction technique uses cartilage from behind the ear and skin from the shoulder to repair the nose in one step after skin cancer. These tissues are shaped into a new nostril, which is tricky because the nostril must not lift up or droop down, and because the nostril is critical for breathing.

“The nose is a fairly complicated area to reconstruct,” said senior author Jeffrey Moyer, MD, of the University of Michigan Comprehensive Cancer Cancer and an associate professor of otolaryngology at the U-M Medical School.

The most common method for nostril reconstruction requires taking cartilage from one part of the body and skin from the cheek or forehead to create a special skin flap. The skin flap stays in place for about 3 weeks so that the blood vessels can grow in the new spot. It looks very conspicuous during that time. Patients come back to the operating room for a second procedure in which surgeons finish the procedure by removing the flap. The tissue and blood vessels have grown over the cartilage, ensuring everything stays in place. Typical results look good and the nostril functions correctly.

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 scale of 1 to 5 (1 is best), the average cosmetic result was judged a 2.3 – considered to be good to very good, with minimal scarring that was not distracting to the patient's appearance.

“This could save people a lot of effort and time. The last thing people want to do is return to the OR,” Moyer said. “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, they often have other medical conditions that make that second procedure unadvisable.

“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 said.

The results from the first 20 patients appear in JAMA Facial Plastic Surgery (doi:10.1001/2013.jamafacial.25).

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