Skirt Flap for Nasal Alar Reconstruction

Sir:

The usual choices for reconstruction of nasal alar defects are a nasolabial flap or a composite chondrocutaneous ear graft. For reconstruction of small full-thickness defects of the ala, the nasolabial flap is difficult because the narrow pedicle and long flap may cause an inadequate blood supply.

We designed a new method: skirt flap for nasal alar reconstruction. It can be recommended as a secondary reconstruction for small defects of the nasal ala. The flap, with a pedicle of the nasal ala, is formed from the nasal floor, upper lip, and cheek along the alar crease, like a skirt (Fig. 1). The ala is pulled ventrally, and the flap is sutured like closing a skirt (Fig. 1). The defect of the donor site is closed by advancing the cheek skin flap medially, and the area that is to be attached to the new alar base is deepithelialized and sutured to the new reconstructed alar base. If the alar base moves after the operation because of contracture, the new alar base of the skirt flap should be fixed by sutures to the piriform margin or maxilla at the time of operation or later. This flap is recommended as a secondary reconstruction of the nasal ala because the alar base is used as a pedicle of the flap. It cannot be used for simultaneous reconstruction at the time of alar tumor resection.

Fig. 1.

A, The skirt-like flap is taken from the nasal floor, upper lip, and cheek along the alar crease. B, The ala is pulled ventrally, and the flap is sutured like closing a skirt. C, The defect of the donor site is closed by advancing the cheek skin flap medially, and the area that accepts the new alar base is deepithelialized.

A 32-year-old woman who had had a resection of rhabdomyosarcoma and radiation therapy in childhood had a small defect and cranial deviation of her nasal alar base caused by scar contracture (Fig. 2). The left nasal cavity was narrowed. A skirt flap was elevated for reconstruction of the alar defect, the donor site was reconstructed with a lateral cheek skin flap, and the nasal narrowing was successfully treated. After operation, the left ala was pulled cranially by scar contracture. The new left alar base was fixed by nylon sutures to the maxilla 1 month after operation. The postoperative clinical course was uneventful. Follow-up at 1 year and 10 months showed a good natural shape of the alar base (Fig. 2).

Fig. 2.

Case 1. A, A 32-year-old woman who had a small defect and cranial deviation of her nasal alar base. B, Results 1 year and 10 months after operation.

As representative reconstructions of local flaps for nasal alar defects, nasolabial flaps have been reported.^1,2 To obtain good results by the nasolabial flap, 2-stage procedures are necessary.³ When reconstructing a small defect of the nasal ala, an insufficient blood supply may be a cause for concern because of the narrow pedicle and long flap. Our method is good for small alar reconstruction and does not need 2 operations. The chondrocutaneous composite graft from the ear is used for the reconstruction of full-thickness defects.^4,5 A graft larger than 10 mm is not suitable for reconstruction because of the limited blood flow. Patients who have received radiation therapy are worried that a composite graft will not take completely. Our method is also indicated for patients who had radiation therapy and do not want a graft from the ear.

PATIENT CONSENT

The patient provided written consent for the use of her image.