Assessment of Amplified v-Y Flaps for Nasal Defect Reconstruction

Abstract

The skin of the nose is relatively adherent to the underlying structures secondary to deficient subcutaneous tissues. This may interfere with local flap recruitment, as in the nasal tip, and thus it is difficult to utilize traditional V-Y flaps to close large nasal defects. The addition of an amplified limb as a transposition flap onto the advancing edge of the V-Y flap is considered. This limb is utilized from the remaining nasal skin adjacent to the defect being reconstructed and is attached to the end of the V-Y flap after its advancement to close the remaining defect. The objective is to assess the use of amplified V-Y flap in closure of relatively large nasal defects incorporating nasal tissue itself on one session. Nasal defects as large as 3.2 cm have been closed with this flap following excision of skin tumors on the nose in 14 patients over 40 years old. Most of the patients were satisfied with aesthetic end results, except in two patients with only trivial complications.There was partial necrosis at the tip of the amplified portion of the flap in the nasal dorsum and sidewall regions. Other patients were concerned about dog ears at the base of the transposed flaps that settled later on spontaneously. Conclusion and recommendation: It is advisable to use the amplified V-Y flap in reconstruction of relatively large nasal defects as one stage procedure with expected good aesthetic outcome.