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The patient is a 62 year old who has two areas of basal cell carcinoma on his naris.
The patient underwent Mohs Surgery. This is a technique which has very tight control of all excised margins to make sure the tumor has been completely resected.
A nasolabial flap was outlined to fill the defect. The intervening skin between the two defects was excised.
The final length to base ratio of this flap was 3.0 tot 1 (after the tip is trimmed during defect closure).
The flap is elevated and rotated into position.
The final appearance after surgery is shown in this picture.
Note that the final incision had to be reclosed along the posterior base. In retrospect it would have been better NOT to make this part of the flap but to advance the cheek tissue to allow for closure.
The advantage of making this incision is that it allowed for flap advancement and removed tension.
At four days out the flap had venous congestion. Greater than half the flap was involved. The patient was already taking Trental 400 mg TID to promote blood flow.
Three days later the flap looks much better with the distal tip showing the most reduced blood flow. 
At eight days out a dry escar forms over the flap. It is important not to remove this
Two Week Post-Op Appearance: From the original flap appearance, over 50% of the compromised flap survived without sequelea. Trental and the avoidance of any additional trauma were key to this improvement.
One Month Post-Op Appearance: The escar is contraction. It is important not to remove since there is viable tissue underneath. 
Two Month Post Op Appearance. Not the lack of swelling at the flap's tip which is commonly seen with nasolabial flaps. Thus, fortuitous for the patient, the partial necrosis and delayed healing may have resulted in an improved cosmetic result.
Two Month Post Op Appearance. Not the lack of swelling at the flap's tip which is commonly seen with nasolabial flaps. Thus, fortuitous for the patient, the partial necrosis and delayed healing may have resulted in an improved cosmetic result.
