Alar facial sulcus and nasal ala reconstruction: a challenging anatomical area.

Abstract

Background Most nasal cutaneous malignancies occur on the caudal third of the nose. Commonly, following resective surgery, the surgeon is requested to reconstruct the ala. Small skin defects of the nose may be left healing by secondary intention, although this may sometimes create an unpleasant scar. In the present paper we describe a 1-step reconstruction of the distal area of nasal ala, alar facial sulcus and cheek, with a segmented melolabial interpolated flap. Methods A 59-year-old man was operated for basal cell carcinoma involving the distal area of nasal ala and alar-cheek sulcus. The reconstruction was performed in 1-stage with a segmented melolabial interpolated flap used to reconstruct the anatomical missing subunits. Results Tumor-free margin was larger than the infiltrating region. No postoperative complications were observed. Conclusions The melolabial flap is a suitable option for the reconstruction of the nose, although the reconstruction of nasal ala is usually performed in 2-steps: the first one is performed to transfer the tissue and close the defect; the second, is performed to reshape the convexity of the ala and the concavity of the alar facial sulcus. In the present case, we do not perform a 2-steps reconstruction, we just reshaped the flap to perfectly fit the defect in 1-stage. The flap, supplied by collateral arteries from the facial and angular arteries, could be segmented for a better surgical outcome also during the harvesting stage if multiple anatomical subunits have to be reconstructed, with no need of a second surgical step that could be frustrating for the patient.