Case 12 2026: Closure of defect on ala nasi with modified shark island flap

Keywords: Shark island flap, facial skin defect, BCC, nasal skin cancer, nasal reconstruction, reconstructive surgery Authors: Mickie Bang Christensen (MD), Magnus Avnstorp (MD), Department of Plastic- & Breast Surgery, Zealand University Hospital Roskilde, Denmark Abstract This case presents the use of a modified shark island flap for reconstruction of a defect on the ala nasi following excision of a basal cell carcinoma in a 85-year old male. Due to the tumor size and location, direct closure was not feasible. The shark island flap was chosen as the reconstructive approach. Surgery was done under local anesthesia. Excision of the tumor was done with a 3 mm margin. Histology from frozen sections showed clear margins without malignancy. Postoperative follow up at both one week and two months demonstrated a satisfactory cosmetic outcome and no signs of recurrence. Patient medical history 85-year old male with a medical history of atoxic goiter, hypertension, Parkinson's disease, melanoma and multiple skin carcinomas, was referred with 3 facial skin carcinomas (dorsum nasi, right ala nasi and left side of the upper lip). This case focuses on the carcinoma on the ala nasi. The biopsy showed basal cell carcinoma of nodular subtype. The patient had years prior been operated with a bilobed flap due to a skin carcinoma on the right dorsum nasi, which had resulted in bulging of the right side of the dorsum. Before and After Patient examination Well preserved male with poor skin quality. On clinical examination, a tumor measuring 6 x 5 mm and 2 mm elevation from the surface of the skin was found on the right ala nasi, involving the nasal sulcus. Clinically not adherent to underlying tissue. There were no palpable regional lymph nodes. Pre-operative considerations Surgery and radiation were discussed with the patient. The patient preferred surgery. Due to the tumor size and location, direct closure was not feasible. FTSG would delete the alar-facial sulcus, create a big,