Patient - Reconstruction

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Click on an image below to see a larger version.

Before

This gentleman had a large skin cancer on his nose. A dermatologist removed using Moh's surgery. This required 7 separate excisions to achieve complete removal and was done over 7 hours in the office under straight local anesthesia. This is very traumatic to patients. I can remove such skin cancers with IV sedation or general anesthesia in my ambulatory center or the hospital and rarely require more than two excisions to get clear margins. Then, I can reconstruct the defect immediately. In this case, once the dermatologist was done, the defect was much too large for them to close and he was sent to me, arriving in my office with a big dressing over his nose. The surface of the wound had been extensively cauterized and needed to be debrided down to healthy tissue. Because of the extent of the surgery adn the urgency of covering the cartilage (exposed cartilage can die and result in a higher chance of infection and deformity of the nose), I did this the very same day I saw him. I did this at the hospital and covered the wound with a material called Integra Wound Matrix. This protects the wound, keeps it moist, and encourages ingrowth of healthy tissue which will allow me to use a skin graft later. 

After

His completed  reconstruction is shown. The first two photos were taken 4 months after the graft was placed. The third was 2 1/2 years later. The brusing around his mouth is unrelated and due to a recent fall.