Island Flap Research Articles

Maxillectomy and Flap Reconstruction of Maxillary Defects After Cancer Ablation Through the Lip-Split Parasymphyseal Mandibulotomy Approach in Patients With Advanced-Stage Maxillary Malignant Tumors.

The conventional approach for maxillectomy has some common and serious complications. The present study evaluated the outcomes of maxillectomy and flap reconstruction after cancer ablation using the lip-split parasymphyseal mandibulotomy (LPM) approach. Twenty-eight patients with malignant tumors, including squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma, underwent maxillectomy through the LPM approach. Brown classes II and III were reconstructed with the facial-submental artery submental island flap, an extensive segmental pectoralis major myocutaneous flap, and a free anterolateral thigh flap with the use of a titanium mesh, respectively. All proximal margin frozen section specimens showed negative surgical margins. Anterolateral thigh flap failure occurred in 1 patient, whereas ophthalmic and mandibulotomy complications developed in 4 and 7 patients, respectively. In all, 84.6% of the patients had satisfactory or excellent lip esthetic results. Of the patients, 57.1% were alive with no evidence of disease, whereas 28.6% were alive with disease and 14.3% died of local recurrence or distant metastasis. No significant survival difference was evident among the squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma groups. The LPM approach can provide good surgical access, facilitating maxillectomy in advanced-stage malignant tumors with minimal morbidity. Facial-submental artery submental island flap and anterolateral thigh flap or extensive segmental pectoralis major myocutaneous flap with a titanium mesh are ideal techniques for reconstructing Brown classes II and III defects, respectively.

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Reconstruction of Upper Extremity Using Pedicled Latissimus Dorsi Myocutaneous Island Flap and Skin Graft after Necrotizing Fasciitis: A Case Report

Necrotizing fasciitis of the upper extremities is a severe, life-threatening condition, potentially resulting in amputation or death in the absence of prompt and aggressive surgical treatment. Reconstruction is eventually required after adequate surgical debridement, and patients are often referred to a plastic surgeon for this purpose. Herein, we present the case of a patient with extensive soft tissue defects on the upper extremity after fasciotomy for necrotizing fasciitis. We successfully performed a pedicled latissimus dorsi myocutaneous island flap, full-thickness skin graft, and split-thickness skin graft for this patient. After 2 months, the patient did not have any wound problems and could carry out adequate upper extremity motion.

Submental island flap - should we be worried about lymph node transfer? An anatomical and histological study

The submental island flap has been increasing in popularity for both oncological and non-oncological reconstruction of the head and neck. However, the original description of this flap left it with the unfortunate designation as a lymph node flap. There has thus been significant debate on the oncological safety of the flap. In this cadaveric study the perforator system suppling the skin island is delineated and the lymph node yield of the skeletonised flap is analysed histologically. A safe and consistent approach to raising the perforator flap modification is described and the pertinent anatomy, and an oncological discussion with regards to the submental island perforator flap histological lymph node yield discussed. Ethical approval was received from Hull York Medical School for the anatomical dissection of 15 sides of cadavers. 6 x 4cm submental island flaps were raised following a vascular infusion of a 50/50 mix of acrylic paint. The flap size mimics the T1/T2 tumour defects these flaps would usually be used to reconstruct.The submental vascular anatomy, including length, diameter, venous drainage patterns, and the skin perforator system was documented. The dissected submental flaps were then histologically examined for the presence of lymph nodes by a head and neck pathologist at Hull University Hospitals Trust department of histology. The total length of the submental island arterial system, the distance from where the facial artery branches off from the carotid to the submental artery perforator entering the anterior belly of digastric or skin, averaged 91.1mm with anaverage facial artery length of 33.1mm and submental artery of 58mm. Vessel diameter for microvascular reconstruction was 1.63mm for the submental artery and 3mm for the facial artery. The most common venous anatomy drainage pattern was the submental island venaecomitantes draining to the retromandibular system then to the internal jugular vein. Almost half the specimens had a dominant superficial submental perforator allowing the ability to raise this as a skin only system. There were generally 2-4 perforators passing through the anterior belly of digastric to supply the skin paddle.73.3% (11/15) of the skeletonised flaps contained no lymph nodes on histological examination. The perforator version of the submental island flap can be safely and consistently raised with inclusion of the anterior belly of digastric. In approximately half the cases a dominant superficial branch allows for a skin only paddle. Due to the vessel diameter, free tissue transfer is predictable.Venous anatomy is variable and care needs to be taken when raising this flap. The skeletonised version of the perforator flap is largely devoid of nodal yield and on oncological review a 16.3% recurrence rate is equivalent to current standard treatment.

Modified Keystone Perforator Island Flap Techniques for Small- to Moderate-Sized Scalp and Forehead Defect Coverage: A Retrospective Observational Study

We aimed to demonstrate the effective application of keystone perforator island flap (KPIF) in scalp and forehead reconstruction by demonstrating the authors' experience with modified KPIF reconstruction for small- to moderate-sized scalp and forehead defects. Twelve patients who underwent modified KPIF reconstruction of the scalp and forehead from September 2020 to July 2022 were enrolled in this study. In addition, we retrospectively reviewed and evaluated the patient's medical records and clinical photographs. All defects (size range, 2 cm × 2 cm to 3 cm × 7 cm) were successfully covered using four modified KPIF techniques (hemi-KPIF, Sydney Melanoma Unit Modification KPIF, omega variation closure KPIF, and modified type II KPIF) with ancillary procedures (additional skin grafts and local flaps). All flaps (size range, 3.5 cm × 4 cm to 7 cm × 16 cm) fully survived, and only one patient developed marginal maceration that healed with conservative management. Furthermore, through the final scar evaluation with the patient satisfaction survey and Harris 4-stage scale, all patients were satisfied with their favorable outcomes at the average final follow-up period of 7.66 ± 2.14 months. The study showed that the KPIF technique with appropriate modifications is an excellent reconstructive modality for covering scalp and forehead defects.

One-stage repair of proximal hypospadias by in situ tubularization of the transverse preputial island flap

PurposeThis study aimed to compare the efficacy of modified transverse preputial island flap (TPIF) repair with the traditional TPIF procedure and Byar’s two-stage procedure in proximal hypospadias repair, especially in the postoperative urethral stricture incidence rates.Materials and methodsPatients admitted for proximal hypospadias treated with modified TPIF repair, the traditional TPIF procedure, or Byar’s two-stage procedure at our institution from 2017 to 2021 were identified, and the incidence of postoperative complications among them was compared.ResultsIn total, 142 patients were included (modified TPIF group, 43; traditional TPIF group, 37; and Byar’s two-stage group, 62). The length of the neourethra was 4.21 ± 0.63 cm in the modified TPIF group, 4.18 ± 0.71 cm in the traditional TPIF group, and 4.20 ± 0.68 cm in the Byar’s two-stage group. The rate of urethral stricture in the modified TPIF group (two cases, 4.65%) was significantly lower than that in the traditional TPIF group (four cases, 10.81%) (P = 0.008). Seven (16.28%) cases of urethrocutaneous fistula occurred in the modified TPIF group, six (16.22%) in the traditional TPIF group, and eight (12.90%) in the two-stage group. Additionally, one case (2.33%) of urethral diverticulum occurred in the modified TPIF group, one (2.70%) in the traditional TPIF group, and three (4.84%) in Byar’s two-stage group.ConclusionsModified TPIF repair can ensure a wedge anastomosis between the proximal urethral meatus and the neourethra, provide support and blood supply for the neourethra. Furthermore, it extended the urethral plate width at the anastomosis and urethral meatus, effectively reducing the incidence of urethral strictures.

Fingertip degloving injury coverage with homodactyle bipedicled dorsal island flap

ObjectivesTo investigate the curative effect of repairing digital degloving with flaps from the bilateral dorsal branch of the proper digital artery of the same finger. Material and methodsTwenty-three patients with fingertip degloving injury treated with flaps from the bilateral dorsal branch of the proper digital artery of the same finger in our hospital from February 2020 to March 2022 were retrospectively included. Active finger range of motion, cold intolerance, pain on visual analogue scale and patient satisfaction were evaluated. ResultsThere were 3 cases of flap blister and 2 of vascular crisis after the operation, all of which healed after symptomatic treatment. All the other flaps and skin grafts survived. Follow-up ranged between 6 and 25 months (mean, 13.8 months). The skin flap was full in shape and soft in texture. Incidence of cold intolerance was low in the palmar flaps and dorsal flaps, and finger range of motion recovered well. The technique relieved pain, and patients were satisfied with the results. ConclusionFlaps from the bilateral dorsal branch of the proper digital artery of the same finger were effective for repair of fingertip degloving. The technique easy to implement, and can repair large defects; the repaired finger shows good function and appearance.

Versatility of Local Fasciocutaneous Island Flaps for Resurfacing Soft Tissue Defects Overlying the Achilles Tendon.

Reconstruction of soft tissue defects overlying the Achilles tendon has always been a challenge. Various modalities of reconstruction have been described to resurface such defects. We aimed to assess the functional and cosmetic outcomes of all patients who had undergone reconstruction of small and medium sized soft tissue defects of the Achilles region using local fasciocutaneous island flaps. This retrospective study was conducted from January 2020 to June 2022. 15 patients with small (≤ 30 cm2) and medium (30-90 cm2) sized soft tissue defects of the tendo-Achilles region, underwent reconstruction with local fasciocutaneous island flaps and had complete medical records, were included. Thirteen patients were male (86.7%). The mean age was 53.2 years. 5 cases (33.3%) had post-traumatic open AT injuries with skin avulsion, while ten patients (66.7%) had suture line complications after open repair of spontaneous Achilles tendon rupture. Defect sizes ranged from 12 to 63 cm2. Reverse sural flap was used in 5 patients (33.3%) and medial plantar flap in 10 patients (66.7%). All flaps survived completely. Complications were detected in 3 patients (20%); 1 distal superficial necrosis in a sural flap and 2 marginal minimal graft loss. Functional outcome was good in 12 patients (80%), excellent in 1 patient (6.7%) and fair in 2 patients (13.3%). 13 patients (86.7%) were satisfied with the cosmetic results. Local fasciocutenous island flaps are reliable and simple solutions for covering small to moderate soft tissue defects overlying the Achilles Tendon, with acceptable functional and cosmetic outcomes.

Comparison of Treatment Methods of Thumb-Tip Defects With Phalangeal Bone Exposure: Modified Heterodigital Neurovascular Island Flap Versus Free Lateral Great Toe Flap

Modified heterodigital neurovascular island flaps and free lateral great toe flaps are dependable methods for treating thumb-tip defects with phalangeal bone exposure. We retrospectively analyzed and compared the details and results of the two methods. This retrospective study included 25 patients with thumb injuries with phalangeal bone exposure treated between 2018 and 2021. Patients were categorized as per the following surgical methods: (1) modified heterodigital neurovascular island flap (12 patients, finger flap group) and (2) free lateral great toe flap (13 patients, toe flap group). The Michigan Hand Outcome Questionnaire, aesthetic appearance, Vancouver Scar Scale, Cold Intolerance Severity Score, static 2-point discrimination, Semmes-Weinstein monofilament, and range of motion of the metacarpophalangeal joint of the injured thumb were evaluated and compared. In addition, operation time, hospital stay, return-to-work time, and complications were recorded and compared. In both groups, the defect was successfully repaired, with no cases of complete necrosis. The 2 groups had similar mean scores in static 2-point discrimination, Semmes-Weinstein monofilament, range of motion, and Michigan Hand Outcome Questionnaire scores. The aesthetic appearance, scarring, and cold tolerance of the toe flap group were better than the finger flap group. The operation time, hospital stay, and return-to-work time in the finger flap group were shorter than the toe flap group. The finger flap group had 2 complications-a superficial infection and 1 case of partial flap necrosis. The toe flap group had 3 complications-a superficial infection, 1 case each of partial flap necrosis, and partial skin graft loss. Both treatments can achieve satisfactory results; however, they each have advantages and disadvantages. Therapeutic IV.

Excellent Closure of Postauricular Defect Using Type-1 Keystone Perforator Island Flap: An Alternative Facial Reconstruction Technique

The use of local flaps is a common and effective method for reconstructing various post-surgical defects. Some advantages of local flaps compared to other methods such as skin grafts are the relatively high success rate and lower complication rates such as infections and wound dehiscence. There are various methods of flaps available and choosing the proper method is based on various factors such as the size of the defect, anatomical location of the defect, and operator capabilities. Therefore, an effective but simple local flap method with a high success rate is needed especially when dealing with defects located on prominent cosmetic areas such as the face. We report the successful use of the keystone perforator island flap for closure of a facial defect caused by basal cell carcinoma removal in a 76-year-old female patient. Although not commonly used for facial reconstruction, this paper reports successful use of this relatively simple and effective method prompting the potential for increased usage in treating small-moderate sized defects on the face.

Is Supraclavicular Artery Island flap (SAI) a viable alternative to Free Tissue Transfer (FTT) in head and neck reconstruction? A systematic review and meta-analysis.

PurposeThe aim of this study is to compare the outcomes of Supraclavicular Artery Island (SAI) Flap versus Free Tissue Transfer for head and neck reconstruction. MethodsWe performed a systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database according to the PRISMA guidelines. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed. ResultsEight studies, reporting a total of 402 patients and same number of flaps, 165 of which underwent reconstruction using supraclavicular artery island flap and 237 reconstructed with free tissue transfer were identified. No statistically significant differences were observed regarding major complications, total flap necrosis, partial flap necrosis, post operative fistula formation, donor site dehiscence, recipient site dehiscence and total flap area. ConclusionSupraclavicular artery island flap and free tissue transfer seem to be comparable when used in head and neck reconstruction.

The second dorsal metacarpal artery flap relaying the dorsal island flap of the index finger for the repair of soft tissue defect of thumb

To investigate the effectiveness of the second dorsal metacarpal artery fascial vascular pedicle retrograde island flap relaying the dorsal island flap of the index finger in repairing skin and soft tissue defects of the thumb. The clinical data of 8 patients with skin and soft tissue defects of thumb between October 2019 and January 2021 were retrospectively analyzed. There were 3 males and 5 females with an average age of 35 years (range, 18-52 years). The causes of injury included machine injury in 2 cases, crush injury in 3 cases, and cutting injury in 3 cases. There were 2 cases of dorsal defect of the proximal part, 1 dorsal defect of the distal part, and 5 instances of the distal part defect. The skin and soft tissue defects ranged from 1.7 cm×1.4 cm to 3.0 cm×2.5 cm. The time from injury to flap repair was 7-21 days, with an average of 14 days. Firstly, the dorsal island flap of the index finger (dorsal side of the proximal part of the index finger) was used to repair the defect of the thumb. Then the second dorsal metacarpal artery fascia vascular pedicle retrograde island flap (near the radial side of the back of the hand) was used to repair the dorsal defect of the index finger; the donor site was sutured directly. Vascular crisis of the flap occurred in 1 case within 48 hours after operation, and the flap was bloated and bruised in 1 case due to excessive suture tension, and all the flaps survived after symptomatic treatment; partial skin margin of the flap was necrotic in 1 case after operation, and the incision healed after dressing change; the other 5 flaps survived, and all the wounds in the donor and recipient sites healed by first intention. All the 8 patients were followed up 3-10 months, with an average of 6 months. One patient had mild scar; the other patients had no significant difference in the color of the flap and the surrounding skin, no adhesion of tendons, and little interference of index finger function, and there was no obvious pain and dysfunction in the donor and recipient sites of the flap. At last follow-up, the extension-flexion range of motion of the metacarpophalangeal joint of the thumb was 0°-55°, and that of the interphalangeal joint was 0°-75°; the extension-flexion range of motion of the metacarpophalangeal joint of the index finger was 0°-82°, that of the proximal interphalangeal joints was 0°-90°, and that of the distal interphalangeral joints was 0°-65°. The application of the second dorsal metacarpal artery fascial vascular pedicle retrograde island flap relaying the dorsal island flap of the index finger to repair skin and soft tissue defect wounds of thumb is a feasible treatment with reliable blood supply, less postoperative complications, no need for skin grafting, less interference to the function of the index finger, and satisfactory wound repair effect.

Successful Use of WALANT in Local and Regional Soft Tissue Flaps: A Case Series.

A retrospective review was performed. Twenty-one patients who underwent a local or regional soft tissue flap surgery using the WALANT technique from February 2, 2018 to February 25, 2022 were included in our analysis. Overall, one Louvre flap, two posterior tibial artery perforator propeller flaps, two reverse radial forearm flaps, two Quaba flaps, six cross finger flaps, one reverse homodigital island flap, three first dorsal metacarpal artery flaps, two thenar flaps, and two Moberg flaps were performed. Patients were followed up for an average of 11.9 ± 8.1 weeks. During this time, no postoperative complications occurred. All patients demonstrated appropriate healing at donor and recipient sites. Full range of motion was regained for all patients. WALANT is safe and effective for use in local and regional soft tissue flap surgery. Surgeons should consider this technique for more involved procedures such as flap surgery, as preliminary results demonstrate positive outcomes and potentially superior recovery for patients.

Littlers Heterodigital Neurovascular Island Flap: Regarding the First Authorship and Our Own Experiences

We clarify the claim to the authorship of the first description of the heterodigital neurovascular island flap, describe different variants and present a series of 15 cases with clinical examples.

Reoperation frequency after transverse preputial Island flap urethroplasty "Duckett's technique" in treatment of severe hypospadias: A single center study.

Transverse Preputial Island Flap Urethroplasty (TPIFU) is one of the most common techniques for treating severe hypospadias. Studies on the reoperation frequency after TPIFU is lacking. In the present study, we reported our clinical outcomes of severe hypospadias treated with one-staged TPIFU and analyzed the operation frequency. We retrospectively analyzed the clinical data of severe hypospadias patients who underwent one-stage TPIFU from December 2018 to December 2019 in the department of Urology at Beijing Children's Hospital. A stepwise approach was used to manage the curvature. Severe hypospadias was defined as those residual curvature was higher than 30° after degloving. Urethroplasty complications included fistula, urethral stricture, and diverticulum. The short-term cure was identified as no complications occurring for 12 months after the date of last-time surgery. The reoperation rate and operation frequency of TPIFU were analyzed. A total of 136 patients who underwent one-stage TPIFU were included in the study. The follow-up after primary urethroplasty ranged from 22 to 50 months. The median age at primary surgery was 22.5 months (range from 13 to 132 months). After primary TPIFU surgery, 53 (39%) patients underwent additional surgical interventions to treat postoperative complications. Among them, 24 patients (17.6%) developed fistula, 17 patients (12.5%) developed urethral stricture and 11 patients (8.1%) developed diverticulum. After the second surgery, five patients remained fistula, five patients remained urethral stricture, and seven patients remained diverticulum. Overall, 61% (85 patients) met the cured standard after the primary operation, and the two operations cure rate was 87.5% (119 patients). 91.2% (124 patients) were cured in three operations. Although the complication rates after primary TPIFU were relatively high, more than half of patients achieved short-term cured through a single operation, and the cure rate after two or three operations was acceptable.

The internal mammary artery perforator flap for neck reconstruction after palliative resection of advanced anaplastic thyroid cancer: a case report

IntroductionDefects of the neck after palliative resection of exulcerated tumors could be reconstructed with different skin flaps.Case presentationThe present report describes the case of a 40-year-old Caucasian female patient with advanced anaplastic thyroid cancer. The exophytically growing, bad-smelling massive exulcerated tumor caused an esthetic defect, neck mobility restrictions, and mental state deterioration.Primary diagnosis, interventions, and outcomesPalliative debulking of the tumor was performed. The 10 × 5 cm skin defect of the neck was successfully reconstructed with an internal mammary artery perforator island flap. The donor site was closed primarily. The patient had an uneventful clinical course; the cosmetic results and mental state were very pleasing.ConclusionsThe present case illustrates that palliative resection of the tumor and plastic reconstruction of the neck defect promoted other treatments such as radiation or chemotherapy due to the improved local situation.

Comparison of Distally Based Sural Fasciocutaneous Island Flap with a nd without Inclusion of Sural Nerve

Objectives: To compare the inclusion and exclusion of the sural nerve in fascio-cutaneous flap repair for lower extremity reconstruction in terms of flap survival, flap size, recovery of skin sensation and complications.
 Study Design: Prospective comparative study
 Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Mar 2020.Methodology: A total of 54 patients (27 in each Group) requiring distal lower limb flap reconstruction and meeting the inclusion and exclusion criteria were included. Patients with a higher probability of flap complications and those with complications during the procedure were excluded. Group-A patients underwent fascio-cutaneous flap repair with sural nerve preservation, while Group-B patients underwent the same technique, but the sural nerve was transected and raised with the flap. All patients were followed for flap survival, flap size and degree of sensory recovery and flap-related complications.
 Results: Varying degrees of return of sensation were seen in 25(92.6%) patients of Group-A after six months, which was 23(63.1%) in Group-B (p<0.001). Flap survival was comparable in both groups: 26(96.3%) and 25(92.6%) patients in Groups A and B, respectively (p=0.552). The complications were also comparable, 4(14.8%) in Group-A and (25.9%) in Group-B, which was not statistically significant (p=0.209).
 Conclusion: Preservation of the sural nerve results in little or no sensory loss in the lateral part of the foot, with complication rates and flap survival comparable to cases where the nerve is sacrificed.Keywords: Distally based sural fascio-cutaneous Flap, Distal lower limb flap coverage, Sural nerve preservation.

The islanded nasolabial flap for tongue reconstruction – Experience in our institute

Background: Oral cancer ranks in the top three of all cancers in India, which accounts for over thirty per cent of all cancers reported in the country. Tongue cancers make a significant percentage among the oral cancer burden. Unfortunately, patients rarely present to the surgeon with a tongue cancer lesion small enough for a primary closure. Hence we frequently need some type of flap for reconstruction of the tongue defect following ablative surgery. In defects that are not small enough for a primary closure as well as not big enough for a more bulky flap like the PMMC or the free ALT flap, the islanded nasolabial flap is of great use to the surgeon for tongue reconstruction and should be part of the reconstructive armamentarium of every oral cancer surgeon. Aims and Objectives: To assess the difference in post-operative speech results between patients having flap reconstruction versus patients having primary closure, and to assess the complications of islanded nasolabial flap reconstruction. Materials and Methods: Retrospective study of 6 months with 11 patients having islanded nasolabial flap reconstruction and 18 patients having primary reconstruction. Results: Post-operative speech results of patients with flap reconstruction were as good as those having primary closure. Conclusions: Islanded nasolabial flap may be a good option for reconstruction of carefully selected tongue defects.

Supraclavicular Artery Island Flap in Head-and-neck Reconstruction: Our Experience

Background: Reconstruction of head-and-neck cancer defects is a challenging task, keeping in mind the complexity of the defects. Locoregional pedicle flap reconstruction is not an inferior option. The supraclavicular flap gained popularity in 1997 to reconstruct mentosternal contractures in postburn patients. This is a perforator-based pedicled, axial, and fasciocutaneous flap based on the supraclavicular artery. This study aims to examine a series of cases with pedicled supraclavicular flap reconstruction in head-and-neck cancers. Methods: This study is a retrospective review of patient data from our institution from 2018 to 2020. A total of seven patients were included who underwent surgical resection for various head-and-neck cancers. Surgical defects were reconstructed with a supraclavicular islanded fasciocutaneous flap. Results: All patients underwent wide excision of the tumor following oncological principles, and four out of seven patients received postoperative adjuvant radiotherapy. Two patients with parotid tumors underwent facial skin excision along with total parotidectomy. Both cases were recurrent. One patient had partial necrosis of the distal part of the flap. Two patients required split-thickness skin graft for the closure of the donor site. Conclusion: Supraclavicular artery island flap (SCAIF) is one of the good reconstructive options for midline neck defects, simple oral cavity defects, and cheek skin defects. It is an excellent alternative to free tissue transfer with limited donor-site morbidity. Careful selection of patients is key to successful reconstruction using a SCAIF in the head-and-neck region.

Reconstruction of the Nasal Columella of an Adult Patient with Nasolabial Subcutaneous Island Flap after Resection of a Dermoid Cyst

Dermoid cysts located in the nasal region are a kind of congenital lesions and may appear as a nasal swelling in the midline. Although nasal dermoid cysts are usually diagnosed during childhood, they can rarely be detected in adulthood. The most important feature that distinguishes nasal dermoid cysts from other Dermoid cysts of the body is that they can extend into deeper structures in the nose and even into intracranial area. Therefore, it is recommended to perform a good physical examination and a detailed imaging method such as computed tomography and magnetic resonance imaging before the operation. Although the nasolabial island flap is a good option for Columella reconstruction, the flap should be followed-up closely for possible circulation problems.