Intrasubunit V-Y Muscle Sling Myocutaneous Island Advancement Flap for Small Defects Isolated to the Nasal Ala

Abstract

BACKGROUND The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae. OBJECTIVE To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects. MATERIALS AND METHODS A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS). RESULTS A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm2. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes. CONCLUSION The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala.

Reconstruction of Distal Nasal Defects With a Large Postauricular Skin-Fat-Fascia Composite Graft

“…The techniques used for nasal reconstruction include direct primary closure, skin grafts, and free flaps. Local and pedicle flaps have been widely used in nasal reconstruction, as these flaps provide good coverage and are similar in color to the native skin 10,11 . However, the disadvantages of these flap techniques are the limited availability of adjacent skin, additional facial scarring resulting from the flap resection, central facial donor site defect, and the need for 2-stage surgery.…”

“…The successful survival of the large composite grafts was mainly attributed to the rich blood supply of the distal nose. The primary blood supply to the distal nose mainly comes from the lateral nasal artery, columellar artery, and inferior alar artery, which branches from the facial artery; there is also a dense anastomotic network between these arteries and the superior labial artery 10,18,19 . Although trauma or tumor resection may compromise the blood supply of the distal nose, adequate blood supply to the defect area can be derived from the vessel anastomotic network.…”

“…The primary blood supply to the distal nose mainly comes from the lateral nasal artery, columellar artery, and inferior alar artery, which branches from the facial artery; there is also a dense anastomotic network between these arteries and the superior labial artery. 10,18,19 Although trauma or tumor resection may compromise the blood supply of the distal nose, adequate blood supply to the defect area can be derived from the vessel anastomotic network. In such a highly vascularized recipient site, the distal nose can support a large composite graft in cases with partial-thickness defects.…”

Reconstrução nasal após cirurgia micrográfica de Mohs: análise de 208 casos

“…9,[28][29][30] The nasal ala was the only subunit where graft was the main repair method despite numerous described flaps from the ala itself. 31,32 Because of the lack of support and the fact that the ala is a free margin, any minimal flaw when designing flaps from the ala itself can cause local distortion. For this reason, this author usually prefers grafts for small defects 33 and secondary intention when the alar sulcus is involved, or a combination of both (Figure 6).…”

How We Do It: Alar Advancement Flap for Small Medially Based Alar Defects

“…Guzman and colleagues 1 described the myocutaneous island pedicle advancement flap for small medial alar defects. Their description and results from this report are excellent; however, it is a technically challenging flap to execute owing to the need to retain at least one of the alar branches of the lateral nasal artery from which the flap derives its blood supply.…”