I have a small superficial defect on my nasal tip that has bothered me for years resulting from a traumatic accident. I was advised by a dermatologist that I should let it by secondary intention before I consider any reconstructive surgeries. It has been 2 years now and it is still very noticeable. I would like to have my nose the way it was before. Will a local (or any) skin flap actually give good aesthetic results or will it make it worse? (I have medium-dark skin, does that matter? )
Cosmetic Results of Local Skin Flap?
Doctor Answers 2
A local flap can work very well.
The nasal tip is a very aesthetically sensitive area. Depending on the size of the defect, secondary intention can sometimes, albeit rarely, heal inconspicuously. As we often see in trauma and cancer, local skin flaps offer a means of moving tissue to cover the defect. However it is imperative that the surgeon understand the nasal anatomic subunits and excise/reconstruct accordingly. Once complete, these local flaps often heal with minimal scarring and present a superior cosmetic result.
Healing by second intention can create bad looking scars
Loss of skin tissue on the face can be due to trauma, infection or skin cancer surgery. Doing nothing but dressing changes until the wound heals (healing by second intention) has proven to be adequate in specific areas and very inadequate in other areas. Areas that should never be allowed to heal by second intention are the tip of the nose because it always leaves unsightly dents and near the inner corner of the eyes because that can leave you with an unsightly web of skin over the area. Wounds at the outer nasal lip junction tend to heal very nicely by second intention. If you allowed an area to heal by second intention and now do not like what you are left with your surgeon will have to remove the scar tissue to recreate the original defect and then surgically correct that defect in order to get the best looking result.
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