Outcome Study after Nasal Alar/Peri-alar Subunit Reconstruction: Comparing Paramedian Forehead Flap to Nasolabial Flap

Abstract

Objective: Contours of the lower nasal third are unique and present challenges in surgical reconstruction. The nasal alar intricate curved anatomy makes the area easily compromised after Mohs surgery. Managing patient and surgeon expectations with regard to aesthetics and functionality remains the reconstructive goal. The purpose of the study was to compare patients’ perspective on aesthetics and functional outcomes of nasal alar reconstruction post Mohs ablative surgery using nasolabial or forehead flaps. Methods: A single surgeon’s results of 23 patients, who underwent nasal alar reconstruction post Mohs surgery, were included for analysis (15 forehead and 8 nasolabial flaps). Initially, 103 consecutive patients undergoing nasal reconstruction were reviewed, with 67 excluded due to nonalar subunit involvement and an additional 13 excluded for other discussed reasons. Mean follow-up period was 2.3 years. Evaluation of a patient satisfaction questionnaire assessed aesthetics and functionality and also surgical scar noticeability. Additionally, 3 board-certified plastic surgeons assessed postoperative images. Results: Twenty-three patients completed the survey. There was no statistically significant difference in gender ratio, follow-up time, or scar noticeability among groups. A difference was noted in both aesthetics and functionality score ( P < 0.03) for both variables favoring forehead flaps. Results from the surgeon’s questionnaire also confirmed the superiority of forehead flaps concerning scar, alar contour/symmetry, and nostril opening symmetry. Conclusions: The forehead flap has a better functional and aesthetic outcome and an overall superior level of satisfaction post Mohs ablative surgery.

Reconstrucción de ala nasal derecha posterior a resección amplia con colgajo nasogeniano interpolado

“…Se ha descrito su utilización exitosa para cubrir defectos cutáneos del ala nasal, tanto vestibulares como externos, en los defectos del labio superior, mejilla e incluso para el piso de la boca, tunelizados a través de la mejilla. 4,[7][8][9] El pedículo dominante es la arteria angular, rama terminal de la arteria facial, con una longitud de 1 cm y 0.5 mm de diámetro. Se localiza lateral a la comisura oral, entre los músculos orbiculares de los labios y el elevador del labio superior.…”

“…12 El colgajo se debe elevar de inferior a superior en un plano subcutáneo, dejando de 1 a 2 mm de tejido celular subcutáneo distalmente y se hace progresivamente más profundo mientras se desarrolla un pedículo en sentido superior y este pedículo de grasa se crea mediante la disección perpendicular a la incisión de la piel hasta el plano por encima de la musculatura facial medial. 7 Existen pocas desventajas reportadas en la bibliografía. La piel distal de las mejillas tiene vello y puede llevar tejido con folículos a la nariz, por lo que requiere una planificación cuidadosa y técnica quirúrgica fina.…”

Paramedian forehead flap reconstruction for skin tumors involving central subunit of face: An analysis of 37 cases

“…Among the various local flaps available paramedian forehead flap is good, versatile and simple, especially for defects involving dorsum of nose, medial aspect of both eyelids and adjacent skin. [1][2][3] Use of paramedian flap does not require a plastic surgeon and can be done by the operating surgeon himself. This saves cost and time.…”