Case 5a Inferiorly Based Nasolabial Flap

Since the vascular supply of the nasolabial flap is through the nasolabial artery, it would appear logical to have the flap based inferiorly. This flap is ideally suited for small defects of the lateral aspect of the nose in its lower half (Figure 4-8). The elevated dis-

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Figure 4-8. A, This superficial lesion of the lateral nose was a basal cell carcinoma. B, The extent of surgical excision and in inferiorly based nasolabial flap have been marked out. C, Immediate postoperative appearance of the flap set into the surgical defect. The donor defect is closed primarily. D, Postoperative appearance of the patient 6 months later.

tal part of the flap is rotated downward and anteriorly to fill the surgical defect. However, the length of a flap used in this way is limited since the skin at the root of the nose near the medial canthus is rather tight and little flexibility is available for closure of the donor site defect.

Edema of the flap and slight duskiness is not unusual on the first postoperative day. Although the flap may look dusky or bluish, its vascularity is guaranteed; the discoloration is usually due to venous congestion, but the arterial blood supply of the flap is usually intact. Satisfactory healing of the skin is achieved in approximately 5 to 7 days. Excessive fat retained on the flap will result in a so-called fat flap, which may require defattening under local anesthesia; but this procedure is not recommended for at least 6 months to a year. If sufficient care is taken to match the thickness of the flap to the thickness of the surgical defect with appropriate excision of excess fat from the flap at the time of the closure, one can avoid a fat flap complication. Postoperative appearance of the patient several months later shows an excellent cosmetic result with essentially very little facial deformity at either the donor site or along the nasolabial skin crease.

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