Facial Cosmetic Surgery to Reconstruct the Nose
Facial cosmetic surgery to reconstruct the nose after Mohs surgery usually requires the use of nasal flaps. There are two types of nasal flaps called Axial Flaps or Random Flaps. Axial Flaps are supplied with an artery from either the opthalmic artery or the facial artery while Random Flaps are supplied from some unnamed blood vessels.
There are several advantages and disadvantages to both types of nasal flaps. One advantage of the Axial Flap is that it has excellent blood supply since it is supplied by arteries. It is also useful for reconstructing nasal tips and surrounding areas. It tends to provide an aesthetically pleasing and functionally efficient nose.
A disadvantage is that two surgeries are required and the patient has to wait several weeks with a flap pedicle over his face or even with his lips sewn together for a month to a month and a half depending upon which part of the face or forehead the flap is coming from.
One advantage of the Random Flap is that it can be used to close large defects in areas where the skin tissue has decreased amount of stretch, such as, on the scalp. It can also be used for varying types of defects. A disadvantage of the Random Flap is that since it is supplied with smaller blood vessel rather than arteries, it runs a higher risk of flap necrosis. Flap necrosis is where the flap loses part or all of its blood supply and the tissue starts to die. When this happens, further surgery is required and extensive scaring may occur. The end result may then not be as aesthetically pleasing.
If a forehead flap is lost, it is usually as a result of inadequate venous return which then causes venous stasis. Venous stasis most often occurs within two to four days after surgery. This is when the arteries connect with the tissue and begin supplying blood, but the venous drainage hasn't yet increased to accommodate the extra amount of blood in that area. Visitors to the patient may be offput by the treatment for this which includes the use of bloodletting with leeches. The leeches produce an enzyme that temporarily prevents the blood from clotting in that region and also desensitizing the area. Here is a link to a picture of leeches being used after a facial flap surgery.
Patients should be particularly mindful of several things following plastic surgery with nasal flaps. This includes being careful when wearing glasses that rest on the bridge of the nose. It is recommended that patients tape the glasses to their face if possible until their physician gives the okay to do otherwise. Patients should also use an antibiotic ointment three times a day or as directed by their physician. They should also take care not to get the flap wet until at least 24 hours after the skin seals shut.
One of the most important post-op concerns a patient should have involves watching for signs of flap necrosis (death of skin). One of the signs of flap necrosis is cyanosis. Cyanosis is indicated by a lack of pink color to the skin or a darkish blue or gray color. This should be reported immediately to a physician no matter if it is a weekend or after business hours.
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