๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Trapdooring and pincushioning
Trapdooring and pincushioning
Undermining widely will reduce the focal scarring that can cause trapdooring or pincushioning of the inferior- most portion of the flap. Undermining to the nasofacial junction bilaterally encourages a more uniform and platelike contraction of the entire lower nose. This reduces the โpuffinessโ of the flap relative to the surrounding skin.
Furthermore, assure that the flap thickness matches that of the defect. This can be achieved by removing any remaining subcutaneous tissue from the defect, and, if necessary, trimming fat from the incoming flap. The flap should be flush or slightly lower than the surrounding skin immediately postoperatively. At that point, any edema that develops around week 4 can be confidently diagnosed as simply edema due to the dependent location of the primary lobe. The patient can be reassured that this will resolve with massage and time. Infrequently, small volumes of intralesional triamcinolone may be injected to improve the scar-associated edema.