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Recreation of the alar crease using the inverted horizontal mattress suture technique
Recreation of the alar crease using the inverted horizontal mattress suture technique C. Helen Malone, MD, and Richard F. Wagner, Jr, MD Galveston, Texas
SURGICAL CHALLENGE Nasal ala defects after tumor resection require primary reconstruction of the alar crease to delineate the adjacent subunits: the nasal ala, nasal sidewall, and medial cheek. Effacement of the alar crease is more difficult to reconstruct secondarily and creates an unnatural webbed appearance. The inverted horizontal mattress technique is a simple method of creating a practically invisible scar for primary reconstruction of the nasal ala.
SOLUTION After negative margins are achieved for a primary basal cell carcinoma with Mohs micrographic surgery, bilateral dog ears are excised in a curvilinear fashion following the natural curve of the alar crease. Dermal sutures are placed. Inverted horizontal mattress sutures (Fig 1) are placed to provide mild inversion of the closure recreating the natural alar crease.1 Simple interrupted sutures are placed. The postoperative dressing is left in place for 48 hours, and then the patient starts daily wound care with mupirocin and a dry dressing. Sutures are removed 7 days postprocedure. The inverted horizontal mattress suture technique yields a superior aesthetic result with negligible additional effort (Fig 2).
Fig 1. Inverted horizontal mattress suture technique.
From the Department of Dermatology, University of Texas Medical Branch. Funding sources: None. Conflicts of interest: None declared. Correspondence to: C. Helen Malone, MD, Department of Dermatology, University of Texas Medical Branch, 301
University Blvd, Galveston, TX 77555-0783. E-mail: chmalone@ utmb.edu. J Am Acad Dermatol 2015;73:e111-2. 0190-9622/$36.00 Ó 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.06.003
e111
e112 Malone and Wagner
J AM ACAD DERMATOL
SEPTEMBER 2015
Fig 2. A, Negative margins after 2 stages of Mohs micrographic surgery with a 0.9 3 0.6 cm defect of the left nasal ala. B, One-week follow-up before suture removal. C, One-week followup after suture removal showing recreation of the alar crease. REFERENCE 1. Wentzell MW, Lund JJ. The inverting horizontal mattress suture: applications in dermatologic surgery. Dermatol Surg. 2012;38:1535-1539.
SURGICAL CHALLENGE Nasal ala defects after tumor resection require primary reconstruction of the alar crease to delineate the adjacent subunits: the nasal ala, nasal sidewall, and medial cheek. Effacement of the alar crease is more difficult to reconstruct secondarily and creates an unnatural webbed appearance. The inverted horizontal mattress technique is a simple method of creating a practically invisible scar for primary reconstruction of the nasal ala.
SOLUTION After negative margins are achieved for a primary basal cell carcinoma with Mohs micrographic surgery, bilateral dog ears are excised in a curvilinear fashion following the natural curve of the alar crease. Dermal sutures are placed. Inverted horizontal mattress sutures (Fig 1) are placed to provide mild inversion of the closure recreating the natural alar crease.1 Simple interrupted sutures are placed. The postoperative dressing is left in place for 48 hours, and then the patient starts daily wound care with mupirocin and a dry dressing. Sutures are removed 7 days postprocedure. The inverted horizontal mattress suture technique yields a superior aesthetic result with negligible additional effort (Fig 2).
Fig 1. Inverted horizontal mattress suture technique.
From the Department of Dermatology, University of Texas Medical Branch. Funding sources: None. Conflicts of interest: None declared. Correspondence to: C. Helen Malone, MD, Department of Dermatology, University of Texas Medical Branch, 301
University Blvd, Galveston, TX 77555-0783. E-mail: chmalone@ utmb.edu. J Am Acad Dermatol 2015;73:e111-2. 0190-9622/$36.00 Ó 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.06.003
e111
e112 Malone and Wagner
J AM ACAD DERMATOL
SEPTEMBER 2015
Fig 2. A, Negative margins after 2 stages of Mohs micrographic surgery with a 0.9 3 0.6 cm defect of the left nasal ala. B, One-week follow-up before suture removal. C, One-week followup after suture removal showing recreation of the alar crease. REFERENCE 1. Wentzell MW, Lund JJ. The inverting horizontal mattress suture: applications in dermatologic surgery. Dermatol Surg. 2012;38:1535-1539.