Nasal defects may have to be reconstructed after skin cancer surgery, due to systemic diseases or after facial trauma. The reconstruction may be needed for either of the three nasal layers: the outer skin, the osteo-cartilaginous framework and/or the inner lining.
Septal perforations, such as seen after prior septal surgery, may be closed with flaps of the internal lining of the nose.
This is a difficult surgery and success depends on the origin and size of the perforation.
Different grafts may need to be harvested to increase the success of the outcome (costal cartilage with perichondrium harvest, nanofat infiltration, local or regional flaps).
Skin Cancer and Reconstruction
Skin and soft-tissue defects after skin cancer removal require meticulous reconstruction to give a result that is as inconspicuous as possible.
Reconstruction involves meticulous surgical technique, experience in closing facial tissue defects and judicious use of tools of scar minimization post-opertively.
The goal of facial scar treatment is to disguise the scar, relocate it, or minimize its prominence. Different types of scars respond to different plastic surgery techniques.
Sometimes surgery is not necessary. It is possible to improve the scar with mechanical (dermabrasion) or thermal (laser) resurfacing.
Many new techniques of bio-modulation and bio-stimulation can improve the profile of the scar (PRP, nanofat, needling, LED and light therapy, lymphatic drainage).
Benign skin lesions and Mole removal
Skin moles or benign skin lesions are common. They can be from birth or occur with age. Most of them are benign but there is a small risk of cancerous changes in some of them. Some moles do resolve but most stay the same or get larger with time.
The main reasons for removal are:
- cosmesis – unsightly mole on the face or multiple mole
- lesions are getting larger
- they are suspicious looking – atypical naevi, Spitz naevus
- previous history of melanoma or skin cancer
- repeated bleeding from trauma
Moles, naevi or other benign skin lesions can be removed by different modalities:
- Cryotherapy (Liquid Nitrogen) – easy but a biopsy is not taken. Effective for solar keratosis and small superficial BCCs and SCCs in situ.
- Curettage with diathermy – the lesion is scraped and the defect is cauterised. This usually leaves a small contracted white scar.
- Radiofrequency (ELLMANN) removal. This is practically a scarless skin lesion removal and the indication is only for cosmesis. The wound is allowed to heal spontaneously. This may take up to 6 weeks. The deep aspect of the mole or lesion may still be present and may recur again.
- CO2 laser vaporization
- Shave excision – the lesion is shaved and allow to heal spontaneously. This may take 3-4 weeks. The deep aspect of the mole or lesion is still present and may recur again.
- Punch excision allows for skin biopsy or excision of very small lesions leaving virtually no scars.
- Surgical excision; the type of excision depends on the type of mole or lesion, size, site, depth and patient skin characteristic and intent.
Simple, superficial lesions can be treated under topical anesthesia. Local anesthesia is the procedure of choice. More complex cases can be are performed under local anesthesia with sedation or general anesthesia.
Scarless Skin Lesion Removal
Scars begin to form when skin injury reaches about a third of the skin thickness.
So for many lesions scars can’t be avoided, but meticulous surgical technique, pre- and aftercare can minimize scar appearance. “Scarless” removal implies superficial controlled skin injury. This can be done by using Ellmann radiofrequency surgery.
Excising of skin lesions with a surgical blade invariable will result in a scar, but this partly depends on the depth of injury of the skin with the blade (eg a scratch does not produce a scar). When more than about a third of the depth of the skin is injured, a scar will result.
Each person scars differently and some people have a tendency towards unfavorable healing (large scars, spread scars, atrophic scars, white scars etc)
There are many technique considerations that will allow for a surgical scar to heal more favorably:
- meticulous surgical technique,
- picking a favorable incision location and scar orientation, as well as
- good suturing techniques are primordial.
- postsoperative wound healing and dressings are also very important to help minimize the scar.
Sometimes one can choose to remove skin lesions with radiofrequency for cosmetic reasons and decrease the chance of a scar. Recurrence might also increase as a result of only partial ablation of the lesion
The Surgitron® Dual RF redefines our surgical results with two distinct frequencies – 4.0 MHz (Monopolar) and 1.7 MHz (Bipolar) – for outstanding surgical precision and control.
We use it for scarless removal of skin growths, warts, moles, seborrheic keratosis.
It is an amazing technology which vaporizes tissue. Recovery is extremely quick and collateral tissue damage minimal.