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J Plast Reconstr Aesthet Surg. 2015 Oct;68(10):1352-7. doi: 10.1016/j.bjps.2015.05.036. Epub 2015 Jun 17.

Flap or graft: The best of both in nasal ala reconstruction.

Author information

1
Mersey Region Plastic Surgery Unit, Whiston Hospital, St Helens and Knowsley NHS Trust, Warrington Road, Prescot, Liverpool L35 5DL, UK.
2
Mersey Region Plastic Surgery Unit, Whiston Hospital, St Helens and Knowsley NHS Trust, Warrington Road, Prescot, Liverpool L35 5DL, UK. Electronic address: jdm.plasticman@hotmail.co.uk.

Abstract

The area of the nose immediately medial to the nasofacial groove is a common site for relatively small but penetrating basal cell carcinomas (BCCs). Although larger lesions may necessitate formal subunit reconstruction, smaller lesions pose a considerable dilemma. Full-thickness skin grafts (FTSGs) often result in an unsightly contour defect. Local flap options exist, but they frequently violate subunit boundaries or anatomical landmarks. In particular, the single-stage nasolabial transposition flap is particularly prone to blunting of the nasofacial angle and fullness or pin-cushioning of the flap with concomitant loss of facial symmetry.

METHOD:

We present a consecutive case series of 21 patients with lesions at this site who underwent reconstruction with a combination of a subcutaneous flap from the adjacent cheek fat, which is then resurfaced with an overlying FTSG.

RESULTS:

A range of defects of dimensions up to 17 mm diameter were included in the series. There were no instances of haematoma, post-operative infection or graft failure. A single patient, who smoked 30 cigarettes daily, underwent a complex reconstruction combining a cartilage graft with a fat flap and a skin graft. He experienced some epidermal loss that healed without intervention, with a remarkable outcome. The results show this to be a reliable and reproducible method that delivers excellent restoration of the contour without disrupting the symmetry of the nasofacial sulcus.

CONCLUSION:

Augmenting a skin graft with a subcutaneous fat transposition flap is a simple technique that is quick to learn and straightforward to execute. Excellent outcomes were consistently obtained without the asymmetry and pin-cushioning often associated with local flaps at this site.

KEYWORDS:

Alar reconstruction; Fat flap; Nasal reconstruction; Skin cancer; Skin graft; Subcutaneous hinge flap

PMID:
26188401
DOI:
10.1016/j.bjps.2015.05.036
[Indexed for MEDLINE]

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