PMC3975202_01
Operative and postoperative patient appearance. a Flap design for basal cell carcinoma removal. The safety margin is set 4 mm from the tumor margin. b The resultant defect involves the areas superior and inferior to the MCT, adjacent to the medial eyelid commissure. c A nasolabial V-Y advancement flap and a glabellar subcutaneous pedicled flap were designed. d The nasolabial V-Y flap is advanced to the lower part of the defect. The glabellar subcutaneous pedicled flap is created. e The glabellar flap is passed through a tunnel to the defect. f The resultant defect of the glabellar area is closed. The wound corresponds to a relaxed skin tension line. g Patient appearance at the end of surgery. h Patient appearance at 6 months postoperatively.
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F1
We excised the tumor with a 4-mm safety margin (fig. 1a). The defect included the areas superior and inferior to the MCT and was adjacent to the medial eyelid commissure (fig. 1b). We planned to separately reconstruct the upper and lower parts of the defect using a nasolabial V-Y advancement flap and a glabellar subcutaneous pedicled flap (fig. 1c). We first advanced the nasolabial V-Y flap from the inferior aspect to create an elliptic defect in the upper part and fixed it to the dermis using 6-0 PDS  II sutures (Johnson & Johnson K.K., Tokyo, Japan) (fig. 1d). We then created a glabellar subcutaneous pedicled flap to match the residual upper elliptic defect with the major axis set along a relaxed skin tension line (fig. 1d). A subcutaneous tunnel was made between the flap and the defect, and the flap was passed through the tunnel to the upper residual defect (fig. 1e). The resultant defect in the glabella was closed in a dermostitch fashion with 6-0 PDS  II (fig. 1f). The skin was sutured with interrupted 6-0 polyvinylidene fluoride sutures (Asflex ; Kono Seisakusho Co., Ltd., Tokyo, Japan) (fig. 1g). At 6 months postoperatively, no tumor recurrence or deformity was evident, and only an inconspicuous scar was present (fig. 1h).