Publications by authors named "James F Thornton"

54 Publications

Use of Biologic Agents for Lip and Cheek Reconstruction.

Semin Plast Surg 2022 Feb 31;36(1):26-32. Epub 2021 Dec 31.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

The unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.
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http://dx.doi.org/10.1055/s-0041-1741399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192158PMC
February 2022

The Use of Biologic Wound Agents in Pediatric Reconstructions.

Semin Plast Surg 2022 Feb 25;36(1):48-52. Epub 2022 Feb 25.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

The indications for using biologic wound agents have expanded greatly since first being employed for acute burn management. The majority of the literature details the use of said agents in the adult population; however, there is little representation regarding their uses for reconstructing defects typically observed in the pediatric population. Ironically, children, and to a lesser extent adolescents, greatly benefit from their use given the reduced skin laxity and amount of surrounding tissue available for locoregional tissue transfer when compared with adults. Herein, we detail the use of acellular and cellular biologic wound agents in the pediatric population.
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http://dx.doi.org/10.1055/s-0042-1742748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192154PMC
February 2022

Biologic Agents in Plastic Surgery.

Authors:
James F Thornton

Semin Plast Surg 2022 Feb 13;36(1). Epub 2022 Jun 13.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

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http://dx.doi.org/10.1055/s-0042-1743454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192153PMC
February 2022

Overview of Biologic Agents Used in Skin and Soft Tissue Reconstruction.

Semin Plast Surg 2022 Feb 15;36(1):3-7. Epub 2022 Feb 15.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Wound healing is a highly complex process mediated by cellular interactions at the microscopic level. Increased understanding of wound healing physiology has served as the foundation for translational research to develop biologic wound care technologies that have profoundly affected patient care. As the reader will see throughout this series in , biologic wound technologies have broad applications and have greatly impacted the reconstructive ladder. Despite their frequent use, many surgeons lack familiarity with the myriad of products available on the market along with each product's relative advantages and shortcomings. This overview will discuss the classification of biologic wound agents used to reconstruct defects of the skin and soft tissue along with the advantages and disadvantages associated with their use.
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http://dx.doi.org/10.1055/s-0042-1742736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192156PMC
February 2022

Technical Refinements with the Use of Biologic Healing Agents.

Semin Plast Surg 2022 Feb 25;36(1):8-16. Epub 2022 Feb 25.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Soft tissue defects resulting from trauma, vascular disease, burns, and postoncologic resections require reconstructive surgery for appropriate wound coverage and support. Dermal substitutes have been applied to a vast array of reconstructive settings across nearly all anatomical areas with demonstrable success. However, they require meticulous handling and operative technical expertise to optimize management of these soft tissue defects. In this review, we will address three dermal substitutes, their operative techniques, and their surgical applications.
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http://dx.doi.org/10.1055/s-0042-1742749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192159PMC
February 2022

Use of Biologic Agents in Nasal and Scalp Reconstruction.

Semin Plast Surg 2022 Feb 9;36(1):17-25. Epub 2022 Mar 9.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Oncologic reconstruction of the nose and scalp following Mohs micrographic surgery poses a significant challenge for plastic surgeons. While these defects are traditionally reconstructed using primary closure techniques, skin grafts, local flaps, pedicled flaps, and free tissue transfer, the incorporation of biologic healing wound agents such as Integra and Cytal provides patients and surgeons with alterative reconstructive options without additional donor site morbidity. Herein, we review the use of biologic agents used in soft tissue reconstruction of the nose and scalp following Mohs surgery.
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http://dx.doi.org/10.1055/s-0042-1742750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192160PMC
February 2022

Nasal Reconstruction after Mohs Cancer Resection: Lessons Learned from 2553 Consecutive Cases.

Plast Reconstr Surg 2021 Jul;148(1):171-182

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Background: Nasal defects following Mohs resection are a reconstructive challenge, demanding aesthetic and functional considerations. Many reconstructive modalities are available, each with varying utility and efficacy. The goal of this study was to provide an algorithmic approach to nasal reconstruction and illustrate lessons learned from decades of reconstructing Mohs defects.

Methods: A retrospective review was conducted of consecutive patients who underwent nasal reconstruction after Mohs excision from 2003 to 2019 performed by the senior author (J.F.T.). Data were collected and analyzed regarding patient and clinical demographics, defect characteristics, reconstructive modality used, revisions, and complications.

Results: A total of 2553 cases were identified, among which 1550 (1375 patients) were analyzed. Defects most commonly affected the nasal ala (48.1 percent); 74.8 percent were skin-only. Full-thickness skin-grafts were the most common reconstructive method (36.2 percent); 24.4 percent of patients underwent forehead flaps and 17.0 percent underwent nasolabial flaps. The overall complication rate was 11.6 percent (n = 181), with poor wound healing being most common. Age older than 75 years, defects larger than 2 cm2, and active smoking were associated with increased complication rates.

Conclusions: Nasal reconstruction can be divided based on anatomical location, and an algorithmic approach facilitates excellent results. Although local flaps may be suitable for some patients, they are not always the most aesthetic option. The versatility and low risk-to-benefit profile of the forehead flap make it a suitable option for elderly patients. Although reconstruction is still safe to be performed without discontinuation of anticoagulation, older age, smoking, and large defect size are predictors of complications.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000008098DOI Listing
July 2021

Scalp Reconstruction after Mohs Cancer Excision: Lessons Learned from More Than 900 Consecutive Cases.

Plast Reconstr Surg 2021 May;147(5):1165-1175

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Background: Scalp reconstruction has evolved over time. Given the large surface area, location, and high likelihood of sun exposure, the scalp is particularly prone to sun damage and skin cancer. Resection of scalp cancers often leaves a large defect that can be challenging for reconstruction. The authors present objective data and recommendations based on more than 10 years of consecutive scalp reconstructions performed by the senior author (J.F.T.). In addition, the authors describe each method of reconstruction and delineate an algorithm based on the senior author's approach and the cases assessed.

Methods: The authors conducted a retrospective review of patients who underwent scalp reconstruction after Mohs cancer excision over a 10-year period. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications.

Results: The senior author (J.F.T.) performed 913 scalp reconstruction procedures. Defects most commonly involved the forehead or vertex of the scalp, with a wide range of sizes. A significant majority of the patients' defects were repaired with the use of adjacent tissue transfer or Integra dermal regeneration templates. There were 94 complications (12.5 percent) noted, ranging from graft loss to cancer recurrence.

Conclusions: Reconstruction of scalp defects after Mohs cancer excision presents the plastic surgeon with numerous patient and defect preoperative variables to consider. Each defect should be evaluated, and a plan based on composition of the defect and the needs of the patient should be developed. Scalp reconstruction is safe to perform in an outpatient setting, even in elderly patients.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000007884DOI Listing
May 2021

Treatment of Non-melanoma Skin Cancers in the Absence of Mohs Micrographic Surgery.

Plast Reconstr Surg Glob Open 2020 Dec 22;8(12):e3300. Epub 2020 Dec 22.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.

Non-melanoma skin cancers are the most common malignancies globally. Although non-melanoma skin cancers exhibit low metastatic potential, they can be locally destructive, necessitating complex excisions and reconstructions. Mohs micrographic surgery is the gold-standard treatment for high-risk non-melanoma skin cancers in patients who are appropriate surgical candidates. Despite its efficacy, Mohs micrographic surgery is not readily available in most geographic regions, necessitating that plastic surgeons be well-versed in alternative treatment modalities for non-melanoma skin cancer. Herein, we will discuss the management of non-melanoma skin cancers in settings where Mohs micrographic surgery is not readily available.
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http://dx.doi.org/10.1097/GOX.0000000000003300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787325PMC
December 2020

Lip Reconstruction after Mohs Cancer Excision: Lessons Learned from 615 Consecutive Cases.

Plast Reconstr Surg 2020 Feb;145(2):533-542

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Background: The lips provide key functional and aesthetic features of the face. From social interactions and speech to swallowing and oral competence, a functional dynamic structure is required. This interaction with surrounding landmarks presents a challenge for reconstruction. There are a myriad of ways reported to reconstruct these defects; however, as the authors' practice has evolved, a more refined approach was developed to optimize results and minimize the complexity of each patient's surgery.

Methods: A retrospective review from 2004 to 2018 was performed of consecutive patients who underwent lip reconstruction following Mohs cancer resection performed by a single surgeon. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications. In addition, the evolution of treatment types over those 14 years was evaluated.

Results: Six hundred fifteen patients underwent lip reconstruction. Defects most commonly involved the upper lateral lip, and 247 (40 percent) involved both the skin and vermillion. A significant majority of the patient's defects were repaired using either linear closure or V-wedge excision and closure. A complication rate of 10.2 percent (n = 63) was found, ranging from oral incompetence to cancer recurrence. There was no significant difference in complication rates in patients older than 75 years, in smokers, or in patients who were on anticoagulation.

Conclusions: The authors' techniques have evolved from more invasive advancement and rotation flaps to a more reliable linear closure method over the past 14 years. This study shows that lip reconstruction is safe in elderly patients, smokers, and patients who are on anticoagulation.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000006509DOI Listing
February 2020

Reply: Current Basal and Squamous Cell Skin Cancer Management.

Plast Reconstr Surg 2019 09;144(3):521e-522e

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

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http://dx.doi.org/10.1097/PRS.0000000000005976DOI Listing
September 2019

Ear Reconstruction after Mohs Cancer Excision: Lessons Learned from 327 Consecutive Cases.

Plast Reconstr Surg 2019 09;144(3):719-729

From the Department of Plastic Surgery, University of Texas Southwestern.

Background: The ear serves many functional and aesthetic purposes, and its complex structure presents a notable challenge for reconstruction. A paucity of objective data and analysis on reconstruction of acquired ear defects remains. The goal of this study was to evaluate all ear reconstructions and the lessons learned over the past decades in treating these complicated defects in a large clinical Mohs reconstruction practice.

Methods: A retrospective analysis of consecutive patients who underwent ear reconstruction after Mohs cancer excision from 2004 to 2018 performed by the senior author (J.F.T) was conducted. Data regarding patient demographics, oncologic type, treatment, defect characteristics, reconstructive modalities, number of stages, and complications were collected and analyzed.

Results: Three hundred twenty-seven patients underwent ear reconstruction. Defects most commonly involved the superior one-third of the helix and the antihelix. Approximately half of the patients' defects were reconstructed with full-thickness skin grafts, and approximately one-third of the patients' defects required flap reconstruction. There were 30 complications (9 percent), ranging from partial flap loss to cancer recurrence. There was no difference in complication rates in elderly patients compared with the younger cohort.

Conclusions: Optimizing results when reconstructing ear defects is challenging, and there are multiple preoperative variables to consider. Ear reconstruction is safe in an outpatient setting, and age should not preclude patients from undergoing reconstruction of ear defects. The lessons learned from the past decade of ear reconstructions are demonstrated, and an algorithmic approach to treating these defects allows for a safe and reproducible method for reconstructing acquired ear defects.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000005992DOI Listing
September 2019

Bioengineered Approach to the Design of a Fat Graft Based on Mathematical Modeling that Predicts Oxygen Delivery.

Plast Reconstr Surg 2019 06;143(6):1648-1655

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Dallas Plastic Surgery Institute; and the Division of Plastic Surgery, Department of Surgery, University of Minnesota Medical Center.

Background: Fat grafting is a common procedure in plastic surgery. A major limitation is unpredictable graft retention, in part caused by inadequate oxygen delivery during the early posttransfer period.

Methods: The authors present a bioengineered approach to the design of a fat graft based on mathematical theory, which can estimate the limitations of oxygen delivery. To simplify the problem, four variables were defined: (1) recipient-site oxygen partial pressure; (2) adipose tissue oxygen permeability; (3) adipose tissue oxygen consumption rate; and (4) fat graft size. Recipient-site oxygen partial pressure and adipose tissue oxygen permeability were estimated from literature, whereas adipose tissue oxygen consumption rate was measured using stirred microchamber technology. Calculations were performed in both spherical and planar geometry to calculate the maximum allowable fat graft size from an oxygen delivery standpoint.

Results: As expected, planar geometry is less favorable for oxygenation but represents a realistic configuration for a fat graft. Maximum allowable fat graft thickness is only approximately 1 to 2 mm at external oxygen partial pressures of 10 to 40 mm Hg; any thicker and an anoxic or necrotic core likely develops. Given a reasonably large surface area and assuming several planes of injection, the maximum allowable fat graft volume is tens of milliliters.

Conclusions: A systematic bioengineered approach may help better design a fat graft. Applying principles of mass transfer theory can predict whether a fat graft has a favorable chance of surviving from an oxygen delivery standpoint and can direct the development of strategies for improved fat graft oxygenation.
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http://dx.doi.org/10.1097/PRS.0000000000005626DOI Listing
June 2019

Discussion: Elegance in Upper Lip Reconstruction.

Plast Reconstr Surg 2019 02;143(2):585-588

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

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http://dx.doi.org/10.1097/PRS.0000000000005289DOI Listing
February 2019

Current Basal and Squamous Cell Skin Cancer Management.

Plast Reconstr Surg 2018 09;142(3):373e-387e

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Learning Objectives: After studying this article, the participant should be able to: 1. Characterize basal and squamous cell carcinomas as low or high risk based on size, location, histology, and clinical features. 2. Understand appropriate surgical margins in low- and high-risk lesions, and other management options, including Mohs micrographic surgery, electrodissection and curettage, topical agents, cryotherapy, photodynamic therapy, and radiation therapy. 3. Discuss adjuvant therapies for locally advanced and metastatic disease, including radiation therapy, chemotherapy, and targeted therapies such as hedgehog pathway inhibitors. 4. Educate patients on preventive measures such as skin examinations, sun protection, oral retinoids, and oral nicotinamide (vitamin B3). 5. Devise a reconstructive plan once clear oncologic margins are obtained.

Summary: With the growing incidence of basal and squamous cell carcinoma, there is an increasing demand for appropriate oncologic management and aesthetic reconstruction. The goal of this CME article is to provide a foundation of knowledge to accurately diagnose, stage, and treat nonmelanoma skin cancers. In addition, it provides the practicing plastic surgeon alternate tools for managing these skin lesions, including topical agents, destructive therapies, and radiation therapy. Lastly, reconstructive plans for selected soft-tissue defects are discussed.
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http://dx.doi.org/10.1097/PRS.0000000000004696DOI Listing
September 2018

Simplifying Lip Reconstruction: An Algorithmic Approach.

Semin Plast Surg 2018 May 14;32(2):69-74. Epub 2018 May 14.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

The authors provide an overview of lip reconstruction after Mohs surgery based on the senior author's practice. Lip reconstruction offers unique challenges to preserve not only lip function but also aesthetics. Lip reconstruction must take into consideration the three anatomical layers that comprise the lip and defects that involve the mucosa, the muscle, the skin or more than one layer will help determine the modality of repair. The authors offer an algorithm based on defect location, tissue involvement, and severity of defect to simplify an often complex decision-making process.
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http://dx.doi.org/10.1055/s-0038-1645882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951711PMC
May 2018

Approach to the Post Mohs Patient.

Semin Plast Surg 2018 May 14;32(2):57-59. Epub 2018 May 14.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

This article discusses the often unique patient presentations and management challenges of the post Mohs resection surgical patient. This includes social, economic, and health issues. Anesthesia considerations and pre- and postoperative care are also discussed in this article.
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http://dx.doi.org/10.1055/s-0038-1646961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951710PMC
May 2018

Facial Mohs Reconstruction.

Authors:
James F Thornton

Semin Plast Surg 2018 May 14;32(2):55-56. Epub 2018 May 14.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

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http://dx.doi.org/10.1055/s-0038-1645883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951702PMC
May 2018

Practical Facial Reconstruction: Theory and Practice.

Authors:
James F Thornton

Plast Reconstr Surg 2017 10;140(4):866

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http://dx.doi.org/10.1097/PRS.0000000000003744DOI Listing
October 2017

Incorporation of Perfluorocarbons into Fat Graft May Improve Oxygenation.

Plast Reconstr Surg 2017 12;140(6):837e-838e

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

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http://dx.doi.org/10.1097/PRS.0000000000003885DOI Listing
December 2017

Reply: Simplifying the Forehead Flap for Nasal Reconstruction: A Review of 420 Consecutive Cases.

Authors:
James F Thornton

Plast Reconstr Surg 2017 12;140(6):835e

Department of Plastic Surgery, University of Texas Southwestern Medical School, 1801 Inwood Road, Dallas, Texas 75390-9132,

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http://dx.doi.org/10.1097/PRS.0000000000003887DOI Listing
December 2017

Reconstruction of a Nasal Defect With a Radial Forearm Flap Following Trauma of a Paramedian Forehead Flap.

Eplasty 2017 29;17:ic18. Epub 2017 Jun 29.

Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5502215PMC
June 2017

Simplifying the Forehead Flap for Nasal Reconstruction: A Review of 420 Consecutive Cases.

Plast Reconstr Surg 2017 Aug;140(2):371-380

Dallas, Texas.

Background: The forehead flap is an important tool in nasal reconstruction. The authors present objective data and recommendations based on over a decade of consecutive forehead flap nasal reconstructions performed by the senior author (J.F.T.). In addition, the authors separate the technique into its individual steps and provide details of the senior author's approach to each.

Methods: The authors performed a retrospective analysis of patients who underwent nasal reconstruction with the forehead flap over a 10-year period performed by the senior author (J.F.T.). Each case was evaluated for defect location, pedicle design, time of division, number of stages, use of cartilage grafts, lining reconstruction, donor-site closure, and complications.

Results: Four hundred twenty patients underwent forehead flap nasal reconstruction. Average time to pedicle division was 32 days. Three-fourths of patients completed reconstruction in two stages. Defects most commonly involved the nasal ala and tip. Approximately half of patients received cartilage grafts and half underwent lining reconstruction. There were 16 complications, ranging from partial flap loss to postoperative death (n = 1).

Conclusions: Confidently grasping the nuances of forehead flap nasal reconstruction arms the reconstructive surgeon with a reliable tool that can effectively treat a variety of defects. It is safe to use in an outpatient setting even in elderly patients. Recommendations include ipsilateral flap design and turn-in component as the first choice for lining replacement.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000003540DOI Listing
August 2017

Rationale and Argument for Subunit Mohs Excision in Nasal Reconstruction.

J Cutan Med Surg 2016 Jul 1;20(4):343-5. Epub 2016 Feb 1.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

Background: Optimal aesthetic results are achieved when nasal defects after Mohs micrographic surgery (MMS) are reconstructed as entire nasal subunits.

Objective: To illustrate the importance of reconstructing the nose in entire subunits and explore the possibilities of expanding the principles of subunit reconstruction to the concept of subunit Mohs excision.

Methods: An 83-year-old man presented for MMS to excise 3 lesions on the nasal ala. The surgeons elected to excise and reconstruct the entire subunit.

Results: Excellent aesthetic and functional results were obtained.

Conclusion: When a defect greater than 50% of a nasal subunit is encountered during MMS, immediate marginal control excision of the entire subunit can be performed with subsequent reconstruction. This technique ultimately has the potential to deliver a more aesthetically pleasing outcome and should be, at the very least, considered by all Mohs surgeons.
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http://dx.doi.org/10.1177/1203475416629594DOI Listing
July 2016

A note on anesthesia for mohs nasal defects.

Semin Plast Surg 2013 May;27(2):127-8

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Patients needing surgical repair after nasal Mohs surgery require immediate prescreening by an anesthesiology provider to determine if the patient is a candidate for the appropriate anesthetic or is to be delayed for more medical evaluation. These patients may need anesthesia anywhere on the spectrum from local anesthesia only to general endotracheal anesthesia, and this may affect where and when the plastic surgeon can proceed.
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http://dx.doi.org/10.1055/s-0033-1351228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743907PMC
May 2013

A note on surgical revisions.

Authors:
James F Thornton

Semin Plast Surg 2013 May;27(2):126

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Surgical revisions are inherent in nasal reconstruction. It is of benefit to the patient if the surgeon is able to accurately counsel the patient on the sequence and expectations prior to embarking on a multistage nasal reconstruction. The requirement to "wait a year" is an unnecessary patient burden, but almost all results improve with time.
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http://dx.doi.org/10.1055/s-0033-1351230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743912PMC
May 2013

Avoidance and management of complications in soft tissue facial reconstruction.

Semin Plast Surg 2013 May;27(2):121-5

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Complications in nasal soft tissue reconstruction are inevitable, and all reconstructive surgeons should be comfortable with their management. Patient and surgical complications can be minimized with appropriate preoperative planning and coordination with the anesthesiologist. When managing undesirable results, it is important to realize that most results will improve over time with appropriate wound care and dermabrasion. Patience and attentiveness to the patient are the most-effective strategies for dealing with poor results.
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http://dx.doi.org/10.1055/s-0033-1351233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743917PMC
May 2013

Repair of combined cheek and nose defects: categorization and utilization.

Semin Plast Surg 2013 May;27(2):117-20

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Combined cheek and nose soft tissue defects can represent a formidable challenge to the reconstructive surgeon. It is important for the surgeon to think of these defects as four separate categories: cheek with nasal sidewall, cheek with nasal sidewall and exposed bone, cheek with nasal sidewall plus ala, and cheek with simple posterior ala defect. This categorization will help the surgeon plan the repair and provide a successful aesthetic outcome. There are multiple repair options that the surgeon can use, and the surgeon should be facile with all types. It is universally agreed that the cheek defect must be repaired prior to undertaking the repair of the nasal defect.
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http://dx.doi.org/10.1055/s-0033-1351232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743910PMC
May 2013

Reconstruction of small soft tissue nasal defects.

Semin Plast Surg 2013 May;27(2):110-6

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Nasal defect repair has been one of the more challenging areas of reconstructive surgery due to the lack of uniform nasal skin thickness and complex contours. Currently, algorithms for medium to large nasal soft tissue defects have been well defined by various authors. Small defects, arbitrarily defined as 1 cm or less, still present significant challenges. In this article, the authors examine the options available to repair small soft tissue nasal defects and the appropriate situations in which each method is best suited.
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http://dx.doi.org/10.1055/s-0033-1351229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743916PMC
May 2013

Expanded uses for the nasolabial flap.

Semin Plast Surg 2013 May;27(2):104-9

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

The nasolabial flap is an excellent choice for use in reconstruction of the nasal alar subunit due to its inherent properties that match skin tone and the convexity of the nose. Often overlooked as an option to use in nasal reconstruction, the nasolabial flap can be very advantageous. Indications for the nasolabial flap can be expanded to include reconstruction of the nasal tip, dorsum, soft triangle, and partial alar defects.
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http://dx.doi.org/10.1055/s-0033-1351234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743915PMC
May 2013
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