How Would You Reconstruct a Large BCC on a Physician?

The discussion revolves around reconstructing a significant basal cell carcinoma (BCC) defect on a retiring pediatrician's face. Panelists propose various surgical options, focusing on the elasticity and laxity of the surrounding skin. Suggestions include using rotation and transposition flaps to borrow loose tissue effectively to minimize tension on the eyelids and achieve functional, aesthetic results. Techniques discussed involve rotation flaps, rhombic flaps, Z-plasties, and specific approaches for nasal defects, such as the nasal labial transposition flap and spiral flap, emphasizing their effectiveness for larger defects while maintaining the natural anatomy. The need for geometric rearrangement of tissue through flap dynamics is stressed, noting that transposition flaps provide advantages in achieving desired lengths and shapes. Various methods for managing secondary defects are also explored, including the use of cartilage grafts for stability in areas like the nasal valve. The discussion culminates in the successful execution of these techniques, demonstrating positive postoperative outcomes for the patients while ensuring seamless integration of reconstructive strategies into their overall facial aesthetics.