Abstract: Reconstruction of Nasal Tip Defects with Superior-Based Pedicle Nasolabial Island Flap

Abstract

INTRODUCTION: Nasal tip reconstruction is a very challenging surgical procedure in aesthetic and reconstructive surgery.1,2 The main purpose of nasal tip reconstruction is to repair with similar texture tissues without disturbing facial aesthetics and function. In this study, reconstruction of the nasal tip defects with superior-based tunnellized pedicle nasolabial island flap is presented. METHODS: 10 patients who were operated for non-melanoma skin cancer including nasal tip area were included in the study. Patient’s medical records were reviewed, digital photography was taken before surgery. All of patients were assessed by detailed physical, ultra-sonographic, endoscopic nasal-airway examination. Each lesion was excised with at least 5mm margin. An elliptical-shaped superior pedicle nasolabial flap was designed based on angular artery. Pedicle of flap was dissected cephalic direction and subcutaneously to the superior of the defect area. The flap was moved to the defect by a tunnel. At the 12th month postoperatively, symmetry of nasal shape and face were evaluated with patient satisfaction scale (-1: not satisfied, 0: neutral, 1: moderate, 2: good, 3: very satisfied). RESULTS: 4 patients were male, 6 female and ages ranged from 61 to 83 years (mean 72.1). In all patients, there was no pathological lymph-node and no internal and external nasal valve dysfunction. Defects were between 4 cm2 and 7.56 cm2 after surgical excision. There were no infection, hematoma and total flap failure; but a partial (20%) flap necrosis due to venous congestion was seen in one diabetic patient and treated conservatively. None of the patients had sensory, speech, chewing and laughing problems after surgery. Temporary sagging of upper lip related to levator muscle damage was seen in one patient, but it improved at 6th month. Three patients were good and 7 patients were very good satisfied with nasal shape and face symmetry. Nine patients reported that the donor side of the face looked like younger than other; one of them didn’t. Nasolabial scar healed uneventfully in all patients. CONCLUSION: Various flaps have been defined for nasal tip defects.3 However, many flaps cause donor site morbidity, seconder intervention for defatting and revision, stage repair. Superior pedicle nasolabial island flap is an alternative flaps used in nasal reconstruction because of texture and color matching, minimal donor site morbidity, good and constant nutrition, safety and transportability to all nasal subunits. Reference Citations: 1. Nogushi M, Matsuo K, Hirose T. Reconstruction of short nose deformity using nasolabial flaps pedicled on the infraorbital vessels. Br J Plast Surg. 1991;44:567–569. 2. Turan A, Kul Z, Tu¨rkaslan T, et al. Reconstruction of lower half defects of the nose with the lateral nasal artery pedicle nasolabial island flap. Plast Reconstr Surg. 2007;119:1767-1772 3.Cox A, Fort M. Nasal Reconstruction Involving Multiple Subunit Defects. Facial Plast Surg. 2017 Feb;33(1):58–66.