A técnica de reconstrução de defeitos localizados na ponta nasal é desafiadora para a cirurgia dermatológica pelo fato de haver pouca pele adjacente disponível e limitada mobilidade. Este relato demonstra que é possível mobilizar a pele adjacente para recobrir o defeito usando retalho com pedículo miocutâneo unilateral que permite maior movimentação e não distorce a simetria do nariz.

Keywords: RETALHOS CIRÚRGICOS, NARIZ, ENXERTO DE PELE

Malignant tumors are relatively common on the dorsum of the hand. Excision of such lesions may result in a large defect not suitable for direct closure, and its reconstruction often represents a challenge for the hand surgeon. Several reconstructive techniques can be used to close this defect. We herein describe the application of a rotation flap for closure of a defect on the dorsum of the hand secondary to excision of a keratoacanthoma, and explain the principles and advantages of this technique.

Keywords: HAND, SURGICAL FLAPS

Flaps are widely used in the surgical reconstruction of the nasal region. During the post-operative period, an unattractive depressed scar in relation to the nearby skin can be observed. Even after abrasion – which the literature recommends 30-60 days after the procedure – this complaint often persists. This study proposes tangential excisions with a razor blade (shaving) of the flap''''''''s entire area until it is level with the surrounding region, followed by dermabrasion to refine any remaining irregularities. The results are deemed excellent since the scars become less noticeable – a very satisfactory outcome due to the aesthetic and social importance of the treated area.

Keywords: SURGICAL FLAPS, NEOPLASMS, DERMABRASION

Summary: Multiple cutaneous miliary osteoma is a rare condition characterized by ectopic bone tissue in the dermis and/or hypodermis. It usually occurs on the face, in individuals of 17 to 79 years old. Its etiology is still unknown. The present article reports the case of a female patient affected by a hardened, poorly delimited, papular plaque of dark brown hue and irregular surface, affecting the malar and mentonian regions. The patient sought medical care two years before the publication of this study, describing untreated acne since the age of 16. The papular plaque was composed of hyperchromic papular nodular lesions – some with white-yellowish hue. The diagnosis was confirmed histopathologically. Satisfactory therapeutic results were achieved with the use of 0.1% tretinoin cream.

Keywords: OSTEOMA; DECALCIFICATION, PATHOLOGIC; OSSIFICATION, HETEROTOPIC.

The present study introduces an advancement and rotation flap that can be used for the reconstruction of surgical defects located in the malar region. The design is essentially a triangle containing the defect, where one line runs parallel to the lateral part of the nose along the nasolabial fold, while another starts at the same point and follows the dynamic lines of the malar region. In order to complete the geometrical shape of the flap, a Burow’s triangle is performed at the end of the fold. The final tension force occurs on the nasal wall, preventing ectropion. The repositioning of the malar fat restores the contour of the region.

Keywords: MOHS SURGERY, SURGICAL FLAPS, ZYGOMA

The dorsum of the hand is home to tumors that often require a surgical approach. Due to limited cutaneous mobility, wide surgical wounds become a challenge to dermatologic surgeons. The authors report the case of a patient with a tumor in the dorsal region of the left hand that, after removal with a safety margin, resulted in a wide surgical wound, and in the choice of reconstruction with an A-T flap. Six months later, the patient was cured, with total preservation of the hand's mobility and excellent aesthetic results. The concept of using flaps for closing wide surgical wounds, whenever possible, is reinforced.

Keywords: HAND, NEOPLASMS, SURGICAL FLAPS.

To make compressive dressings that are capable of preventing hematoma during the recovery period, after surgery on the scalp is a challenge. These dressings can be especially problematic to perform in the vertex region, due to the difficult adhesion of the hypoallergenic tape in that site. The authors introduce a good option for compressive dressings for use after surgeries on the scalp.

Keywords: COMPRESSION BANDAGES; AMBULATORY SURGICAL PROCEDURES; HEAD; SCALP

Among the diverse reconstruction alternatives used in surgical wounds, those employing cutaneous grafts are implemented when the closure – primary or by second intention – is unfeasible or, due to other factors, flaps are not recommend. The repair of surgical wounds using partial thickness graft obtained from the scalp with a flexible blade is described in 3 cases of conventional exeresis (2 basal cell carcinomas in the nasal region and 1 case of squamous cell carcinoma on the dorsum of the hand). The technique yielded good aesthetic outcomes, both in the receiver and donor areas.

Keywords: dermatologic surgical procedures; skin neoplasms; scalp; carcinoma, basal cell; carcinoma, squamous cell; skin grafts

The reconstruction of defects involving up to 2/3 of the lip extension is challenging, considering the functional and aesthetic importance of this structure. There are several surgical techniques described for this purpose, highlighting the Abbé-Estlander flap, the Karapandzic flap, and the Bernard-Burrow- Webster flap. The choice of the best approach should consider the size and location of the defect as well as the comorbidities of the patient. The reverse Yu flap is an alternative to be considered in relation to other methods, allowing obtaining excellent cosmetic-functional results in general.

Keywords: Surgical flaps; Reconstruction; Lip

Cysts are benign epithelial tumors widespread. The trichilemmal cysts, originating from the anagen’s isthmus, represent about 20% of the cysts and are located more frequently in the scalp (90%). Several methods can be used for the removal of the cysts. The choice of technique depends on its characteristics, such as size, mobility, consistency, quiescence, inflammation, and quantity. However, they may grow again if the capsule is incomplete removed. The authors present a simple variant of the marsupialization technique that allows its complete removal.

Keywords: Ambulatory Surgical Procedures; Cysts; Scalp Dermatoses

The giant BCC is a rare variant, and the repair of large defects in the scalp, generated after oncologic resection, is a surgical challenge. We report the case of a patient submitted to late scalp reconstruction after oncologic resection of giant BCC in the scalp with the association of techniques. Reconstruction of scalp lesions depends on a comprehensive understanding of the anatomy of this site, knowledge of the arsenal of surgical techniques, and a detailed assessment of patient factors and expectations, given the impact on the quality of life and morbidity related to each therapeutic option.

Keywords: Carcinoma, Basal Cell; Reconstructive Surgical Procedures; Scalp Dermatoses

Facial surgeries are often challenging for surgeons due to their complex anatomy, aesthetic and functional importance. Interventions in the cosmetic subunit that comprises the eyebrows can be particularly difficult. This case report aims to demonstrate the use of island flap in this region. We performed the excision of melanocytic nevus, with a good outcome and absence of postoperative complications. This technique is commonly used for facial reconstruction; however, the literature describes only a few cases using this method for eyebrow reconstruction.

Keywords: Eyebrows; Reconstruction; Surgical Flaps

The closure of large defects on the nasal dorsum is a challenge for dermatologic surgeons. The alternatives to repair the defect are a skin graft and some forms of skin flaps. One particular defect closure technique is the crescentic advancement flap, which uses crescent incisions at the nasolabial fold to accommodate the excess tissue. This flap is best used if the defect is in the lateral nose, alar, and nasolabial fold. We report a large defect of the nasal dorsum in a 65-year-old woman that was successfully reconstructed using bilateral cheek-to-nose crescentic advancement flap. The patient showed excellent cosmetic and outcome.

Keywords: Dermatology; Nasal Bone; Surgical Flaps

Reconstruction of the scalp after suspected skin lesions excision is a challenge. Tamir et al. described the three-point-advancement (Mercedes flap) to close circular wounds. These tissue advancements create triangles in the edges, which must be removed. However, extensive lesions do not allow the three points to join, preventing central closure. Valesky et al. described the central closure using total skin grafts made from the triangles. The literature lacks these case reports, making it difficult to incorporate them into surgical practice. We applied this modified technique to five patients with good aesthetic and functional results.

Keywords: Scalp; Surgical flaps; Plastic surgery procedures; Skin transplantation; Skin neoplasms

The posterior surface of the ear is an uncommon site for skin cancer. It has anatomical and cutaneous characteristics that make local reconstruction difficult using standard surgical techniques. We present a case of reconstruction of a defect on the posterior surface of the ear secondary to excision of a basosquamous carcinoma, using an interpolation flap.

Keywords: Carcinoma, Basosquamous; Ear; Surgical Flaps