Conflict of interest: none declared.
Viewpoints in dermatology •Correspondence
Making a ‘U-turn’ with sterile adhesive tapes to optimize outcomes in nose and lip reconstruction
Article first published online: 25 JUL 2012
© The Author(s). CED © 2012 British Association of Dermatologists
Clinical and Experimental Dermatology
Volume 38, Issue 1, pages 95–96, January 2013
How to Cite
Mikeljevic, J. and Hussain, W. (2013), Making a ‘U-turn’ with sterile adhesive tapes to optimize outcomes in nose and lip reconstruction. Clinical and Experimental Dermatology, 38: 95–96. doi: 10.1111/j.1365-2230.2012.04433.x
- Issue published online: 18 DEC 2012
- Article first published online: 25 JUL 2012
- Accepted for publication 10 April 2012
Sterile adhesive tapes are widely used in dermatological surgery. Their main use during wound repair is in reducing tension along apposed wound edges. Recently, novel applications for their use have been described, such as facilitating operator independence when closing larger wounds,1 and acting as ‘struts’ for keeping nasal plugs in place.2 We describe two novel uses for sterile adhesive tapes in the repair of defects of the nose or lower lip.
Application 1. Large nasal defects may necessitate complex two-stage reconstruction in the form of an interpolated median or paramedian forehead flap. In people with a low frontal hairline, there may be difficulty in the flap ‘reaching’ the distal area of the nose. If the distal flap is sutured under tension, it may produce a suboptimal result at the aesthetically critical nasal tip. However, making a ‘U-turn’ with sterile adhesive tapes can reduce wound tension at the distal end of the flap, and optimize surgical results. Our technique involves using a wide sterile adhesive tape and placing its centre under the nasal columella, while the surgical assistant directs the nasal tip upwards. The two ends of the self-adhesive tape are then secured to the centre of each cheek, creating a U-shaped sling (Fig. 1a). This simple technique reduces wound tension at the most vulnerable point of the flap, while enabling the patient to breathe without marked impedance.
Application 2. Surgical repair of lower lip defects can often result in significant postoperative wound swelling, and in the case of a mucosal advancement flap for vermillionectomy defects, to wound tension at the junction of the mucosal and cutaneous lower lip. Under these circumstances, the sterile adhesive tape ‘U-turn’ technique requires two tapes fastened together, with the centre placed under the central lower lip. Each arm of the ‘sling’ is adhered to the lower central cheek, ensuring it is beyond the level of the oral commissure on each side, thus creating a degree of superior pull on the lower lip (Fig. 1b). Not only does this reduce labial scar tension, but if so desired, it can be used to limit the extent of oral opening during the first few postoperative days, thus minimizing scar stretch. Furthermore, if so required, it allows a pressure dressing to be held in place in a difficult facial location.
In conclusion, making a ‘U-turn’ with sterile adhesive tapes is a simple method to optimise outcomes in nose and lip reconstruction.