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J Craniomaxillofac Surg. 2017 Mar;45(3):432-435. doi: 10.1016/j.jcms.2016.12.019. Epub 2016 Dec 21.

Levator alae nasi muscle V-Y island flap for nasal tip reconstruction.

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Department of Plastic and Reconstructive Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy. Electronic address:
Department of Maxillofacial Surgery, A.O.U. Federico II, 80131 Naples, Italy.
Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", Istituto Nazionale dei Tumori Fondazione Pascale Napoli, 80131 Naples, Italy.
Department of Plastic and Reconstructive Surgery, A.O.U. Federico II, 80131 Naples, Italy.


Nasal tip reconstruction can be very challenging. It requires close attention to skin texture, colour and thickness matching, with the respect of the nasal aesthetic units and symmetry. Flaps are usually preferred to skin grafts where possible. Based on different donor areas, various flaps have been described for reconstruction of this region. Here we present a new V-Y myocutaneous island flap based on the levator alae nasi muscle (LAN muscle) blood supply. This flap may represent an alternative to the nasalis myocutaneous sliding V-Y flap previously described by Rybka. As its pivot point it is located more cranially than the nasalis flap, and it can advance more medially than the Rybka flap, with the possibility of covering larger defects of the nasal tip area, up to 1.8 cm in diameter. Over the past 5 years, 24 patients received nasal tip reconstruction with this flap following the resection of basal cell carcinomas. Good tip projection was maintained, and the aesthetic outcome was satisfactory, with well healed scars. We recommend this technique as an alternative to other flaps for nasal tip defects, especially if paramedian.


Basal cells carcinoma; Island flap; Levator alae nasi muscle; Nasal tip reconstruction; Nasal tip skin cancers; V–Y advancement flap

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