Full-thickness Nasal Alar Defects Research Articles

Three-Layer Reconstruction of a Full-Thickness Nasal Alar Defect after Basal-Cell Carcinoma Removal

Restoring the integrity of the external nose presents a complex surgical challenge due to its three-dimensional structure and subunit divisions. The most frequent causes of nasal defects include basal or squamous cell carcinoma, animal bites and trauma. The reconstruction approach varies depending on factors such as the defect’s size, the affected subunit of the nose, the condition and quality of the surrounding tissues and the surgeon’s expertise. Commonly employed surgical techniques for nasal reconstruction include the forehead flap, nasolabial flap, Rieger flap, bilobed flap, and free autologous skin graft. We present a clinical case of a patient with a full-thickness nasal alar defect who underwent three-layer reconstruction with a combination of an inverted skin flap- for the internal lining, a conchal graft to substitute the missing alar cartilage and a forehead flap for external coverage. One of the challenges of nasal reconstruction surgery is to restore a full-thickness defect, especially the internal nasal lining. We offer a different perspective on this problem, showcasing considerable advantages, as there are limited literature data on this method.

DermSurgery: A folded nasolabial flap for the reconstruction of a full-thickness nasal alar defect.

DermSurgery: A folded nasolabial flap for the reconstruction of a full-thickness nasal alar defect.

Use of facial vein graft with vascularized composite auricular helical rim flap for alar rim defects

Nasal alar defects lead to facial disfigurement, and nasal ala reconstruction is an important treatment option. The vascularized composite auricular flap based on the superficial temporal artery is an ideal option for a full-thickness nasal alar defect. However, the pedicle length and the discrepancy in artery diameter between the recipient vessel and flap pedicle continue to be major problems for free auricular composite tissue transfer. Considering that the angular artery is occasionally absent and the course of the infraorbital segment of the facial vein is constant, there are often no suitable vessels around the recipient site for anastomoses to the short pedicle of the flap. In the absence of a suitable recipient artery, an infraorbital segment of the facial vein measuring 2.5cm in length was taken as a graft for the anastomosis of the superficial temporal artery and superior labial artery. End-to-end anastomosis was performed easily. The flap was inset to reconstruct the contralateral ala. The facial vein graft for anastomosis of the superficial temporal artery and branch of the facial artery is a reliable and easy method to resolve the problem of a short pedicle and large artery discrepancy for nasal ala reconstruction with a vascularized composite helical rim flap.

Cosmetic results of reconstruction of full thickness nasal alar defects using cheek skin flaps

Objective: to analyze cosmetic results following reconstruction of nasal alar defects using cheek skin flaps. Material and methods. The results of 29 operations were analyzed. The reconstruction was performed with nasolabial flaps and jigsaw puzzle flaps. The cosmetic outcomes were evaluated by the five-point scale by means of patient-report and specialist-report questionnaire. Results. Acceptable overall outcomes were achieved in 22 cases according to the experts’ assessment and in 24 cases according to the patients’ assessment. The highest scores were noted for alar color and position, and the lowest scores - for alar size, shape, and nostril size. The complication rate was 11.1 %. Delayed surgical corrections were undertaken in 10 patients. Conclusion. The reconstruction of full thickness nasal alar defects using cheek skin flaps made it possible to achieve acceptable outcomes with minimal donor site damage in the majority of the patients.

Single-Stage Reconstruction of Full-Thickness Nasal Alar Defect Using Bilobed and Turnover Flaps

Skin cancer of the nose remains a common challenge for the reconstructive surgeon with full-thickness defects being particularly problematic. Reconstruction of the internal nasal lining poses the greatest difficulty with local tissue often having unsatisfactory vascularity or surface area. We describe the reconstruction of a full thickness nasal alar defect in a patient after failed full-thickness skin graft using a single stage procedure combining a bilobed flap with a turnover flap. The patient achieved excellent initial and long-term cosmesis and functionality and was very satisfied with the results. We demonstrate that selected full-thickness nasal alar defects may be reconstructed in a single procedure using a carefully placed turnover flap for the internal nasal lining and bilobed flap for outer skin cover.

Use of a helical composite free flap for alar defect reconstruction with a supermicrosurgical technique.

The highly contoured nature of the nose and the abundant free margin makes it especially difficult to reconstruct. In this report, we describe the use of a new helical rim free flap technique for the reconstruction of full-thickness nasal alar defects via supermicrosurgery. Briefly, after a wide excision with a margin of 0.7 cm, an alar defect with a size of 1×1×0.5cm was obtained, which included the full thickness of the skin, mucosa, and lower lateral cartilage. Vessel dissection was performed in a straightforward manner, starting from the incision margin for flap harvest, without any further dissection for reach the greater trunk of the superficial temporal artery. The flap was inset in order to match the contour of the contralateral ala. We closed the donor site via rotation and advancement. No donor site morbidity was observed, despite the presence of a small scar that could easily be covered with hair. The alar contour was satisfactory, and the patient was satisfied with the results. The supermicrosurgical technique did not require further dissection to identify the vessels for anastomosis, leading to better cosmetic outcomes and a reduced operating time.

Full-Thickness Entire Nasal Alar Reconstruction Using a Forehead Flap in Asians: No Cartilaginous Infrastructural Lining Is Necessary.

Full-thickness defects of the entire nasal ala, including the rim, can be challenging to reconstruct. A forehead flap may provide a more imperceptible and natural-appearing reconstructed nasal ala. Previously, many authors have insisted adding cartilaginous infrastructural support for an entire, full-thickness defect to keep the postoperative alar structure symmetrical. They finally use a forehead flap after thinning of the distal covering portion subcutaneously, possibly for a Caucasian-type nasal ala. However, Asian skin has a thicker and more compact dermis than that of Caucasian skin, and the Asian ala is rounder and thicker. There may be another approach for an Asian-type nasal ala. The authors propose the possibility of nasal alar reconstruction for an entire, full-thickness defect in Asians using a forehead flap without structural support. Six patients with entire full-thickness nasal alar defects treated with full-thickness forehead flaps above the periosteum without structural support were reviewed. Five patients demonstrated esthetically good to excellent outcomes in color, texture, and symmetry. Their nasal linings were reconstructed using mucoperiosteal flaps or mucosal grafts. One patient treated with a nasal lining using a local flap showed a fair result esthetically. Asians forehead above the periosteum has adequate thickness and supportability to reconstruct the entire full-thickness nasal ala in Asians. No cartilage support is necessary.

Reconstruction of a full thickness nasal alar defect following resection of a BCC with a vascularised chondrocutaneous helical rim flap: a case report

Background Nasal reconstruction presents a challenge for plastic surgeons due to the prominent location and complex structure of the nose. When reconstructing full-thickness nasal defects, options to replace the inner lining, cartilaginous framework and outer skin must be considered. The aesthetic units of the nose must also be replaced in full rather than simply filling holes. This report presents a case of a 62 year old male who’s full-thickness alar defect due to resection of a basal cell carcinoma (BCC) was reconstructed using a free chondro-cutaneous helical rim flap based on a retrograde flow superficial temporal artery pedicle.

Reconstruction of full-thickness nasal alar defect with combined nasolabial flap and free auricular composite flap

To investigate the technique and its effect of combined nasolabial flap and free auricular composite flap for full-thickness nasal alar defect. From March 2010 to March 2013, 9 patients with full-thickness nasal alar defects were treated with combined nasolabial flaps and free auricular composite flaps. Composite auricular flap was used as inner lining and cartilage framework. The nasolabial flap at the same side was used as outer lining. All the patients were followed up for 6-18 months (average, 12 months). All the 9 composite auricular flaps survived completely. Epidermal necrosis happened at the distal end of 1 nasolabial flap. Alar rim was almost normal and symmetric nose was achieved in 6 cases. The arc and the thickness of the alar rim was not enough in 3 cases, resulting in asymmetric appearance. The survival area of auricular composite flap can be enlarged with nasolabial flap. The auricular helix edge can be reserved to reconstruct nasal alar rim with smooth and natural arc. Large full-thickness nasal alar defedts can be reconstructed with combined nasolabial flaps and free auricular composite flaps.

Reconstruction of Full-Thickness Nasal Alar Defects Using Cartilage-Supported Nonfolded Nasolabial Flaps

The difficulties faced in the reconstruction of the nasal alar defects are still continuing because of their unique anatomy, free margin, and triple-layered complex structure. In this study, we would like to present the results of the cartilage-supported nonfolded nasolabial flap reconstruction method that we applied to full-thickness alar defects involving the alar rim. Between March 2009 and October 2011, 5 patients with full-thickness alar defects underwent cartilage graft-supported nasolabial flap reconstructions. Three of the patients were men, whereas 2 patients were women. Their median age was 54.2 years (range, 43-62 y). The defects were caused by either tumor excision or trauma. According to the method we applied, cartilage grafts were placed into the pouches formed between the skin and the adipose tissue to provide cartilaginous support to the nasolabial flaps to be adapted to the defect areas. The deep surfaces that were going to form the nasal mucosa were grafted using postauricular full-thickness skin grafts. Patients were followed up for a median period of 7.3 months (range, 3-21 mo). In all patients, the flaps fully fitted the defect areas and provided enough coverage over the defects. Although minimal graft contractions were observed in the later phase because of the cartilage support placed within the pouches formed in the flaps, no nasal airway constrictions were observed.The technique we applied is a simple and reliable method providing adequate framework support, full color and texture harmony, an open nasal passage, and a single-session reconstruction in most cases.

Combined Hinge and Nasolabial Transposition Flap for Repair of a Full-Thickness Nasal Alar Defect

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Repair of Full-Thickness Nasal Alar Defect

Repair of Full-Thickness Nasal Alar Defect

Repair of Full-Thickness Nasal Alar Defect

Geneva, Switzerland Address correspondence and reprint requests to: A.M. Skaria, MD, University of Geneva, Rue de Lausanne 15, 1800 Vevey, Switzerland, or e-mail: [email protected].

A Variation of Composite Grafting for Reconstruction of Full-Thickness Nasal Alar Defects

REPORT OF A CASE A 72-year-old man presented with a biopsy-proven basal cell carcinoma on the right alar rim. Following resection of the tumor, the patient had a 0.9×0.4-cm full-thickness defect of the alar rim ( Figure 1 ). THERAPEUTIC CHALLENGE Removing a malignancy from the alar rim of the nose often results in destruction of the skin, the underlying cartilage, and nasal mucosal lining. These full-thickness defects are difficult to repair because of the need to replace structural support, skin, and nasal lining. SOLUTION This skin and fat variation of a composite graft uses a rectangular-shaped skin and fat graft from the inner upper arm, supraclavicular area, or the earlobe. The graft is removed from the donor site and minimally defatted to approximate the contour of the alar rim. The graft is sutured into the mucosal surface of the defect with 6-0 fast-absorbing chromic gut with the epidermis forming the ''new''