The Rhombic Flap Repair for Mohs Nasal Defects & Tips
One of my favorite Mohs repairs to perform for a nasal defect is: the Rhombic Flap.
Nose reconstructions have grown to be my favorite anatomic location to reconstruct because every nose is unique.
Approaching a Mohs defect is like an artist visualizing how to fix a broken sculpture. You must understand what pieces are missing in order to fill those gaps, cracks, and crevices to achieve the best aesthetic result.
Every reconstruction is a mix of art and science and becomes your masterpiece.
The nose has a distinct topography filled with a myriad of convexities, concavities, creases, and textures that you have to mindfully respect in order to choose the best repair option.
The rhombic flap is a random-pattern, geometric, transposition flap simple to execute (opposed to the bilobed flap for example)! Very versatile and can be used for small to medium sized nasal defects that provide superior cosmesis when compared to other repair options.
So as a surgical dermatology NP/PA, next time you have a small Mohs nasal defect to reconstruct (or if you're assisting your Mohs surgeon)....remember the Rhombic Flap is an excellent choice!
3 main pearls to remember when reconstructing the nose:
- Pay attention to preserving aesthetic subunits. Placement of incisions in creases and borders between subunits leaves a less conspicuous scar
- Understand facial structures and landmarks to avoid tension that can lead to distortion (e.g. any subtle tension to alar rim can cause asymmetry)
- Preserve function of nasal valve when repairing nose. A beautifully repaired nose will be overshadowed if the patient's breathing is compromised! Function always takes precedence over aesthetics!
Next week, I will share a quick video of a case study on the simple steps on how to perform this repair!
ALL my best,
~ Theresa Talens, DNP, FNP-C (TheresaSurgDermNP)
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