# A Surgical Conundrum: Addressing a Large Nasal Defect Following Mohs Micrographic Surgery

## TL;DR

This paper discusses a complex nasal reconstruction case using a double rhomboid flap after Mohs surgery for a large nasal defect.

## Contribution

The paper presents a tailored reconstructive strategy using a double rhomboid transposition flap for large nasal defects.

## Key findings

- The double rhomboid flap effectively addressed skin tension and preserved nasal symmetry.
- The technique provided continuity of surrounding tissue texture, color, and thickness.
- Tailored reconstructive strategies are crucial for optimal cosmetic and functional outcomes.

## Abstract

Managing large nasal defects following Mohs surgery presents complex reconstructive challenges due to the nose's prominent and visible nature. These cases require a careful balance of preserving structural integrity, optimizing cosmetic outcomes, and maintaining vascular health. In situations where primary closure is impractical due to defect size and location, innovative techniques like the double rhomboid transposition flap offer versatile solutions, addressing both aesthetic concerns and functional requirements. The double rhomboid flap allows surgeons to achieve continuity of surrounding tissue, ensuring aesthetically pleasing texture, color, and thickness while minimizing complications like skin tension and potential airway issues. This case highlights the reconstructive challenges faced in managing large nasal defects following Mohs micrographic surgery for basal cell carcinoma. An 84-year-old male presented with a significant nasal defect following Mohs surgery that involved the dorsum, sidewall, tip, and ala, complicating primary closure due to skin tension and cosmetic concerns. Utilizing a double rhomboid transposition flap technique allowed for effective aesthetic and structural reconstruction, addressing skin tension and preserving nasal symmetry. This case emphasizes the importance of tailored reconstructive strategies to achieve optimal cosmetic and functional outcomes in complex nasal Mohs defects.