Case 8: Perialar Crescentic Advancement Flap for Nasal Reconstruction

Keywords: Nasal reconstruction, perialar flap, crescentic, advancement, PCC in situ. Authors: Lukas Kure-Rosenberg, MD and Nicco Krezdorn, MD, Chief. Institution: Department of Plastic Surgery, Zealand University Hospital, Denmark. Abstract We present the case of a 68-year-old woman with a residual PCC in situ on the nasal dorsum following initial excision and open defect by colleague. The initial pathology revealed incompletely excised changes cranial to the primary defect (12 o’clock position). The patient was booked for re-excision and closure, originally planned with a full-thickness skin graft (FTSG). However, the patient expressed high cosmetic expectations, prompting a change in plan to a local flap-based reconstruction. A perialar crescentic advancement flap was chosen, utilizing the planned re-excision site, which anatomically corresponded to a burrow triangle in the flap design. This case illustrates how integrating oncologic and reconstructive planning can optimize both margin control and aesthetic outcomes. Patient medical history A 68-year-old woman was referred for further management of an ulcerating lesion, consistent with biopsy-confirmed squamous cell carcinoma (SCC/PCC) in situ on the nasal dorsum. The patient was routinely seen at dermatological checkups due to being kidney transplanted, and was therefore also recommended surgical management of the lesion. The lesion was initially excised by a colleague and left as an open wound for secondary intention until the final pathological analysis. Pathology demonstrated no invasive tumor, but histopathological evaluation revealed residual SCC in situ/atypical changes at the superior (12 o'clock) margin of the excised area, necessitating re-excision. Before and After Patient examination Upon reexamination, the surgical defect was located centrally on the nasal dorsum, cranial to the supratip area, measuring 12 mm in diameter. The previously excised region had demarcated edges and healthy granulation tissu