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REPAIR OPTIONS: NASAL SIDEWALL
Preferred options when standard side-to-side closure is not possible
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Defects on the nasal sidewall can be closed by accessing skin laxity from the medial cheek.1,2 A potential problem, however, is that wound tension may produce webbing across the concavity of the inner canthus or flattening of the nasofacial sulcus. Optimal cosmesis is likely if scarlines are kept within the cosmetic subunit (ideally, not crossing the midline) and should be placed in, or parallel to, the nasofacial sulcus. Small defects on the sidewall can be closed in a side-to-side manner. Where a flap is required, necrosis is unlikely due the robust blood supply of this highly vascularised tissue with its plentiful muscle and subcutis.
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Scar hides well in, or parallel to, the nasofacial sulcus
Minimal distortion of anatomy
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Pinch the skin to determine the direction of the ellipse. Most side-to-side closures will close in a vertical direction in this location. When defects are higher up on the sidewall or near the medial canthus, the ellipse may be best directed obliquely radiating out from the inner canthal area in the relaxed skin tension lines (Fig. 4.1).
Draw the ellipse.
After anaesthesia, incise and undermine around the ellipse, in the subcutaneous plane.
Place absorbable sutures to close the defect.
Insert the superficial sutures.
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Unilateral Single-Sided Advancement Flap
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The perialar crescentic advancement (PACA) flap described below achieves more tissue movement to repair larger defects than the other East-West flaps discussed in the previous chapter (see Advancement Flaps). On the nasal sidewall, however, the simpler L-plasty design, in which the horizontal limb is closed using the ‘rule of halves’, is often ...