๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Flap execution
Flap execution
First, deepen the defect on the nose to the cartilage, making room for the incoming flap. This will prevent bulk adding to the anticipated temporary trapdooring or edema. The fat directly beneath the pivot point can safely be debulked to further prevent a standing cone deformity.
Detaching the fibrous attachments of the skin from the bony structure of the nose will allow the flap to mobilize and reach as predicted. There are prominent attachments on the mid-nasal sidewall over the attachment of the nasal bone to the upper lateral cartilage. When the flap is undermined at the level of the periosteum, the fibrous bands are released, and skin can be recruited from the medial cheeks to reduce tension on the closure. These fibrous attachments can be released on both sides of the nose.
One disadvantage of this flap is the use of multiple small curved lines that do not follow preexisting skin folds or wrinkles. In theory, one could design a double rhombic flap about a single pivot point with angular lines, or modify each lobe to have pointed tips.13 Both of these designs still require the use of multiple short lines in various directions. Fortunately, sutured lines can be barely noticeable if precise suturing techniques are employed. It is imperative to use deep buried sutures to pull the retracted subcutis and muscle of the flap back to its original position along the suture line. Failure to pull this retracted tissue back to the suture line results in excess tissue under the flap, which can contract and contribute to pincushioning. This can also result in depressed suture lines that are difficult to remove with dermabrasion.