Case 5b Superiorly based Nasolabial Flap Reconstruction for a Complex Defect of the Alar Region

A patient with a recurrent basal cell carcinoma involving the skin of the ala and through the alar cartilage and nasal mucosa into the nasal vestibule is shown in Figure 4-9A. The lesion had previously been treated by electrodesiccation and curettage on two occasions.

The plan of surgical excision requires a through-and-through resection of the ala of the nose including the underlying mucosa, and a superiorly based nasolabial flap is planned for reconstruction of the surgical defect, providing external and inner lining (see Figure 4—9A).

The excision is completed showing a through-and-through defect. The superiorly based nasolabial flap is elevated (Figure 4—9B). The flap is elevated lateral to the nasolabial crease with a generous amount of fat on the undersurface. The tip of the flap is turned in to provide inner lining and the donor defect can be easily approximated primarily.

Figure 4-9. A The patient has a basal cell carcinoma of the skin of the nasal ala adherent to the underlying cartilage and mucosa. The extent of surgical excision is outlined along with a superiorly based nasolabial flap. B, A composite resection including the skin, cartilage and mucosa resulted in a full-thickness alar defect. C, The superiorly based nasolabial flap is elevated and set into the defect. Its tip is turned on to itself to provide inner lining and the donor defect is closed primarily.

Figure 4-9. A The patient has a basal cell carcinoma of the skin of the nasal ala adherent to the underlying cartilage and mucosa. The extent of surgical excision is outlined along with a superiorly based nasolabial flap. B, A composite resection including the skin, cartilage and mucosa resulted in a full-thickness alar defect. C, The superiorly based nasolabial flap is elevated and set into the defect. Its tip is turned on to itself to provide inner lining and the donor defect is closed primarily.

The nasolabial flap used in this way is ideal for repair of a complex defect of the alar region of the nose. The flap is folded over itself to replace the free edge of the ala (Figure 4-9C) and is esthetically quite acceptable. Cartilage support is usually not necessary unless the alar defect extends from the tip of the nose to the region of the nasolabial crease.

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