Laboratory Studies
See the list below:
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Laboratory testing follows standard preoperative evaluation and screening.
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A history of clotting problems or easy bruising indicates that hematological studies or bleeding times may help identify potential surgical risks.
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If general anesthesia is used, other testing, such as ECG, chest radiographs, and chemistry panels, may be indicated depending on a patient's particular health status and anesthetic risk.
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Other preoperative preparations include various methods of optimizing surgical outcome depending on specific medical history.
Maximize the nutritional status of malnourished patients.
Serum albumin levels less than 3 g/dL impair healing.
If a patient's skin has excessive comedones, a brief presurgical course with tretinoin may reduce severity.
Dermabrasion may be used to minimize the degree of rhinophyma and improve recipient site contour.
Patients with diabetes should have tight glucose control to improve healing.
Patients who use tobacco products may be counseled at this time about the significant deleterious effects of nicotine, including compromised flap viability.
Imaging Studies
See the list below:
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No specific radiographic imaging studies are required.
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Preoperative photography is essential to document the defect, allow outcome review and comparison, and educate the patient regarding the condition prior to surgery.
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Confirmation of the supratrochlear artery location and its path up the forehead can be achieved using Doppler studies, angiography, or palpation. These are not typically necessary because the anatomy in this region is consistent.
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A is a median forehead flap over the forehead vasculature. B is the paramedian forehead flap over the forehead vasculature. C is the midline forehead flap over the forehead vasculature.
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The anatomic relationship of the supratrochlear vessels and the periorbital and forehead musculature.
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Aesthetic subunits of the nose.
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Photograph on left depicts a nasal defect following Mohs surgery. Center photograph shows the defect defined in terms of subunits involving the ala, nasal tip, and cheek. Photograph on right shows the completion of the aesthetic subunits and advancement of the cheek flap up to the nasal facial sulcus.
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A is a nasal defect template (from suture package). B is the template transferred to the precise midline of the forehead.
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A is a flap elevation in the subcutaneous plan, superficial to the frontalis muscle. B is a selective thinning to best match normal nasal skin thickness.
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Periosteum incorporated into the pedicle base.
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Midline forehead flap transferred to the nose.
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The left photograph is the planned pedicle division. The right photograph is the pedicle stump partially inset into the glabella.
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The left photograph shows a 2-year postoperative frontal view. The right photograph is an oblique view of the same patient.
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Large nasal defect following excision of skin malignancy.
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Frontal postoperative view.
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Aesthetic units drawn.
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Midline forehead flap outlined.
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Close oblique postoperative view.
