Transposition flap use to repair failed melolabial interpolated flap post basal cell carcinoma excision of nasal region

Abstract

Reconstruction of postoperative defects in basal cell carcinoma (BCC) in the nasal region is quite challenging. Hematoma, bleeding, infection, partial or total necrosis are complications of the procedure. A 72-year-old woman admitted with a non-healing wound on her nose since a year ago. She had a history of hypertension. On dermatological examination of nasal alar, there was an ulcer measuring 1.6x1.7x0.1cm has an uneven surface, irregular edges, erosions, pus, blood and telangiectasia. Dermoscopy and histopathological examination support the picture of nodular BCC. The patient was managed with Mohs microscopic surgery followed by reconstruction of the defect with a melolabial interpolated flap. On the 11th day, necrosis was found on the distal, resulting in a new defect. At week 8, second surgery was performed with a transposition flap. The results of the evaluation at the fourth week showed good wound healing. Comorbidities such as hypertension can disrupt vascularization and interferes with flap oxygenation, causing partial necrosis on the distal of the flap. Transposition flap was used to cover the previous flap failure with good results.