Superiorly based nasalis myocutaneous island pedicle flap with bilevel undermining for nasal tip and supratip reconstruction.

Abstract

Superiorly based flaps with bilevel undermining for the reconstruction of nasal tip and supratip defects have not been utilized to this point for reconstruction of this cosmetic subunit. The purpose of this presentation is to describe a new flap for the reconstruction of nasal tip and supratip defects and to introduce a new method of undermining-bilevel undermining-in the raising of these flaps. In this presentation we demonstrate (diagrammatically and with fresh cadaver dissection) the methods of preparing, raising, and preforming this new flap. We further introduce and describe the concept of bilevel undermining. We describe the first author's 4-year experience in the development of this flap. We show clinical representative cases with pre- and postoperative results. Superiorly based myocutaneous island pedicle flaps with bilevel undermining, a new method of nasal tip and supratip reconstruction, yields excellent functional and cosmetic results. Bilevel undermining is a new and valuable method of achieving greater tissue mobility in muscle-based flaps.