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- Nose Reconstruction After Skin Cancer
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Nose reconstruction after either skin cancer removal or internal nose cancers may involve replacement of various tissues lost from the excision which may include skin, bone, cartilage or soft tissue. Dr. Sam Rizk, a board certified facial plastic and reconstructive surgeon, spent 4 years of his surgical training in nose and face cancer reconstruction at the renown hospitals- Memorial Sloan- kettering Cancer Center and Cornell Medical School/New York Hospital Center. Dr. Rizk continues to teach and lecture on his techniques and innovations at Cornell/New York hospital conferences as well as national and international plastic surgery conferences (see media/publications section of website). Many of Dr. Rizk's innovations have been published in well respected peer reviewed plastic surgery journals.
Dr. Sam Rizk's practice is comprised of 10-15 percent reconstructive surgery after either cancer removal or trauma to the face and nose.
Skin cancers are referred to Dr. Sam Rizk typically after a MOHS excision by dermatologists. A MOHS excision is a micrographic excision intended to preserve normal tissue by examining and mapping surgical borders under the microscope. Dr. Rizk's nose reconstruction is coordinated with the dermatologist ahead of time so that the patient can undergo the reconstruction on the same day as the excision. The excision is performed by the dermatologist and the patient is sent over to Dr. Sam Rizk's center for the reconstruction.
The nose reconstruction performed by Dr Rizk may involve either a local tissue flap from surrounding tissue, a composite graft composed of skin and cartilage (usually harvested from the patient's ear), or a forehead flap. The forehead flap is a last resort as it must remain attached to the nose with a tissue bridge (pedicle) until the new forehead tissue in the nose is able to obtain blood supply from the nose. This may take a few weeks and then the pedicle is cut in a staged surgical procedure and forehead donor site is repaired.
Localized tissue flaps are the best option for many defects and may involve rotation flaps, where tissue is rotated into the defect, an advancement flap where tissue is advanced into the defect or a combination rotation/advancement flap. A free composite graft is a type of tissue transfer if the defect involved cartilage and skin. The donor site such as the ear can provide this composite tissue of cartilage and skin.
After a year has passed from the initial nasal reconstruction, some patients may elect to do a cosmetic rhinoplasty or a laser treatment to improve the appearance or scars in the nose. Dr. Rizk uses either the fractionated co2 laser or microdermabrasion or both to improve scars after nose cancer reconstruction. The cosmetic rhinoplasty after the initial cancer reconstruction typically involves debulking or thinning out the thicker tissue that was transferred into the nose from surrounding tissue. The skin/tissue of the face is thicker than the nasal skin and may create some asymmetry. It is difficult and risky to debulk this tissue in the initial cancer reconstruction procedure because this may compromise its blood supply.
Additionally. Some intranasal functional surgery may be performed to remove bulky tissue/scar tissue which may be blocking the patient's breathing. This can be performed sooner than a year if an internal deformity or scar tissue is visible to improve the patient's quality of life.
Sometimes in major cancer reconstructions additional rib (costal) cartilage from a tissue bank and temporalis fascia (soft tissue obtained from above patient's ear) may be used to build a collapsed nasal bridge from cancer removal. If internal nasal structures have been removed due to cancer, the nose can collapse due to lose of support and in severe cases Dr. Rizk recommends use of costal (rib) cartilage from a tissue bank, to build the collapsed structures which may involve the nasal tip, bridge, or both.
Dr. Rizk visits third world countries to offer free reconstructive services as part of international missions both in South America and Africa. Dr. Rizk feels that Post-Cancer reconstruction is one of most gratifying types of surgery to perform because of its enormous impact on patients.
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