Patient returned following the Mohs excision to the nasal tip and forehead flap reconstruction. Unfortunately the patient has denuded bone in the middle of his forehead donor site. It measures about 1.5x 3 cm. Today I took him to the operating room in the office and cleaned the area thoroughly and under local anesthetic of 1% Xylocaine and 1:100,000 parts epinephrine I mobilized flaps medially and laterally and sutured them together with spanning sutures of 2-0 Prolene. The edges of the wound did not completely come together but the size of the defect was reduced by about 50%. The patient will continue to dress the area wet-to-dry in the hope of encouraging granulation tissue to creep across the wound. If not we can do another closure once the tissue have relaxed.
The patient is now due to have a cartilage grafting to the nasal tip as well as thinning of the nasal tip flap. This should be done as a day case under general anesthetic. The donor site of the grafts will be either the ear cartilage or the rib cartilage so he should be consented for both and he should be booked for 3 hours.
Thank You for your help!!!