Nasolabial perforator flap for one-stage reconstruction of nasal defects

Abstract

Background:The excellent freedom of movement and range of this flap when based on a the nasolabial perforator flap have not been sufficiently explored. In this study, along with demonstrating the other key advantages of this flap over its traditional counterpart, we will endeavour to fill these lacunae in the available literature.Materials and Methods:From February 2009 to February 2012, twenty patients with nasal defects were repaired with a nasolabial perforator flap in the Department of Plastic and Cosmetic Surgery at Sir Ganga Ram Hospital, New Delhi. Of these, two patients (10%) underwent the procedure bilaterally. Thus, a total of 22 nasolabial perforator flap procedures were carried out. Prospectively, collected clinical records and data of each patient were retrospectively retrieved and reviewed to study the nasal defect and surgery done.Results:All the twenty (100%) patients had good functional and aesthetic outcome. All patients who had nasal stenosis preoperatively had very good improvement in the patency of the nasal passages, breathing and nasal blockage with complete recovery of symptoms. The patients were entirely satisfied with the functional recovery.Conclusions:The reliability and versatility of the nasolabial perforator flap exceed its recognised application in reconstruction of nasal defects and it must form a part of every plastic surgeon's armamentarium.

Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap

“…Although handheld Doppler can be helpful for preoperative markings, it is not essential. In previous reports, at least one reliable perforator of a respectable diameter was found lateral to the alar rim, in all cases 6–11 . In our series, we used the handheld Doppler device for preoperative markings and were able to find good perforators in the mentioned area in line with previous studies.…”

“…Venous congestion is a commonly seen problem in nasolabial perforator propeller flaps; like all propeller perforator flaps 7,11 . But, it did not cause flap loss in any of our cases and resolved spontaneously.…”

“…Venous congestion is a commonly seen problem in nasolabial perforator propeller flaps; like all propeller perforator flaps. 7,11 But, it did not cause flap loss in any of our cases and resolved spontaneously. Two of the 5 patients who had venous congestion experienced partial flap loss healed by secondary intention and there was no need for secondary closure operations.…”

“…Along with these advantages, perforator flap surgery requires microsurgical skills and experience. [6][7][8][9][10][11] It is more difficult compared to conventional nasolabial flap, although it does not involve an unusual dissection for the reconstructive surgeon familiar with perforator flap surgery.…”

“…Identifying the perforator vessel also allows raising the flap larger than usual or without complying the traditional width-length ratios. Along with these advantages, perforator flap surgery requires microsurgical skills and experience 6–11 . It is more difficult compared to conventional nasolabial flap, although it does not involve an unusual dissection for the reconstructive surgeon familiar with perforator flap surgery.…”