A Composite Nasolabial Flap for an Entire Ala Reconstruction

Abstract

background. It is difficult to reconstruct an entire alar defect. We report a case of an entire alar reconstruction carried out in two stages with a composite nasolabial flap lined with retroauricular skin and supported with the attached conchal cartilage. objective. A composite nasolabial flap was applied for reconstruction of entire alar defect in this patient. methods. The lining skin for the flap was obtained from retroauricular region acceptable to the patient, and the conchal cartilage was used simultaneously for support and as the attachment for the lining skin. The flap was then replaced and se-cured. Half a year later, the flap was flipped and transferred to the alar defect as a second step. results. The final shape and texture were satisfactory. All procedures were performed under local anesthesia. conclusion. Our design of composite flap has been successfully utilized to repair an entire alar defect with cosmetically and functionally good results, minimizing the donor area and the resulting operation scars. This composite nasolabial flap is thought to be the best choice of a flap for an entire alar defect reconstruction.H. Kakinuma, MD, U. Iwasawa, MD, M. Honjoh, MD, and T. Koura, MD have indicated no significant interest with commercial supporters.

Combination Nasolabial Transposition Flap and Island Pedicle Flap Following Mohs Surgery of Simultaneous Basal Cell Carcinomas Involving Both Nasal Alae

“…Inferiorly, the alar rim is a free margin and the ala is often composed of sebaceous, sun-damaged skin. Defects involving the ala are difficult to repair surgically for the following reasons: the complex contour, the unique color and texture, the need for mucosal lining, the need for support to counter wound contraction, and preservation of a patent air passage [2][3][4] . The topographic complexity of the nasal ala has frequently challenged the cutaneous surgeon.…”

“…Second, the cheek has an extensive and excellent blood supply. Third, because the nasal crease is a prominent facial landmark, the donor site closure was easily hidden in this area 3,7 . But, if the nasolabial flap is used low on the nose, as in our patient, one must always be cognizant of a cheek-nose concavity and the trapdoor deformity.…”

“…The area has topographic complexity and the characteristics of a thick zone, as described by Berget and Mernick 1,2 . Random patterned flaps from the cheek or proximal nose usually obliterate the supraalar crease or the alar rim and may cause nasal valve malformation due to scar contracture 3,4 . Selecting an appropriate local flap is crucial for cosmetic and functional success.…”

Nasolabial Hinge Flap with Simultaneous Cartilage Graft in Nasal Alar and Tip Reconstruction

“…Therefore, the difference between the intranasal and atmospheric pressure is greatest at the nasal valve, and they have the greatest potential for collapse. Any structural damage to the valve results in an occluded air passage during inspiration 10 …”

Re: Kakinuma et al. A Composite Nasolabial Flap for an Entire Ala Reconstruction

“…In response to the article by Kakinuma et al 1 Quite a repair! However, there are several points that need to be addressed in response to how this case was done and some comments that were made in the discussion.…”