PMC3512222_01
To remove the melanoma lesion, a full-thickness defect was created to excise the lower lid from the sidewall of the nose, down to the level of the inferior orbital rim.
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fig1
The eyelid and portion of the upper cheek was removed in toto (Figure 1).
A 2 x 5 cm nasal septal cartilage graft was harvested from the left septum (a). The graft was placed into the defect as a tarsus with the mucosa facing the eyelid (b).
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fig2
A 2 x 5 cm composite nasal cartilage-mucosa graft was harvested from the left septum of the patient and was placed into the defect as a tarsus with the mucosa facing the eyelid (Figures 2(a) and 2(b)).
In a lateral quadrant, dissection of the TPF was carried down to the level of the periosteum (a). The fascial flap was then elevated off the underlying deep temporal fascia (b). At the level of the orbital rim, the flap was retrieved and pulled across the lower lid defect and sutured into the medial canthus area (c).
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fig3
The fascial flap was then elevated off the underlying deep temporal fascia and pedicled entirely on the superficial temporal artery and vein (Figures 3(a) and 3(b)). At the level of the orbital rim, the flap was retrieved and pulled across the lower lid defect and sutured into the medial canthus area over the composite nasal cartilage-mucosa graft (Figure 3(c)).
An elliptical skin graft approximately 5 x 8 cm was removed from the right underarm and was sutured over the TPF.
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fig4
TPF and secured at the cardinal points using buried sutures (Figure 4). The remainder of the closure was completed using a combination of interrupted and running sutures.