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December 1991

The Dual Rhombic FlapA Technique to Utilize Distant Tissue Laxity for Reconstructive Surgery

Author Affiliations

Hospital of the University of Pennsylvania, Philadelphia

Arch Dermatol. 1991;127(12):1772-1774. doi:10.1001/archderm.1991.04520010016001

REPORT OF A CASE  A 68-year-old man underwent Mohs microscopic surgery for treatment of a recurrent basal cell carcinoma involving the left lateral aspect of the nasal tip. The defect resulting from tumor removal measured 1.5 X 2.0 cm (Color Fig 1). Postoperatively, the patient was consulted regarding reconstructive options. Alternatives included healing by second intention, placement of a full-thickness skin graft, and flap repair. The patient expressed interest in achieving a natural-appearing cosmetic end result with minimal visibility of scar lines.

THERAPEUTIC CHALLENGE  The defect was located on the lateral aspect of the nasal tip. Because the patient's nasal skin was moderately sebaceous and was surfaced with telangiectasis, only tissue directly adjacent to the wound would provide a good color and textural match. Various flap options were considered. Advancement and rotation flaps would have a high probability of pulling upward on the nasal rim, creating distortion of the alar

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