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

Padula, Simone La; Abbate, Vincenzo; Monta, Gianluca Di; Schönauer, Fabrizio

doi:10.1016/j.jcms.2016.12.019

Cited by 6 publications

(6 citation statements)

References 16 publications

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“… 11 Recently, also an island V-Y advancement flap, based on the “levator alae nasi” muscle, has been proposed for nasal alar and tip region reconstruction. 12 …”

Section: Discussionmentioning

confidence: 99%

Extended rotation flap for reconstruction of partial thickness defects of the tip and nasal ala region: in search of better aesthetic results

et al. 2021

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Background Basal cell carcinoma is the most common non-melanoma skin cancer of the nose. Defects of the nasal ala and tip region are among the most difficult to repair due to their intrinsic characteristics. Objective To present our experience with the extended rotation flap for reconstruction of nasal ala defects and evaluate the outcome using the Patient and Observer Scar Assessment Scale (POSAS). Methods and Materials Twenty-two patients with partial thickness nasal ala defects reconstructed using the extended rotation flap were assessed. Final cosmetic and functional outcomes were evaluated using the POSAS. Results Flaps survived in all the reported cases and no major complication was recorded. Histology showed complete excision of the tumour in all cases. Using the POSAS, the mean overall evaluation for patients was 1.8/10, while the mean overall evaluation for the evaluation panel was 2.2/ 10. Conclusion Although similar flaps have been previously described, the extended rotation flap for nasal ala and tip reconstruction represents a functionally and cosmetically appealing wound closure option, respecting and avoiding any distortion of the alar crease.

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“… 11 Recently, also an island V-Y advancement flap, based on the “levator alae nasi” muscle, has been proposed for nasal alar and tip region reconstruction. 12 …”

Section: Discussionmentioning

confidence: 99%

Extended rotation flap for reconstruction of partial thickness defects of the tip and nasal ala region: in search of better aesthetic results

et al. 2021

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“…Surgeons with lesser qualifications, or surgeons unfamiliar with surgery of the external nose, should not venture here. 5 , 6 , 8 , 10 , 12 Examples found outside the plastic surgical literature were decidedly poor. 11 , 12 , 13 , 15 , 16 …”

Section: Discussionmentioning

confidence: 99%

“…Some papers report reconstructions that create extensive scarring, when better methods already exist. Yet others succumb to marketing forces with catchy names such as “checkmark rotation flap,” 7 “pincer flap,” 6 and “omega flap.” 12 Others appear to use creative photography, 5 , 13 while some are fantastical flaps that have never been performed as depicted (Banner flap).…”

Section: Discussionmentioning

confidence: 99%

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V-Y Flap for Nasal Reconstruction

Viciana

Lessard

2020

Plastic and Reconstructive Surgery - Global Open

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The nasal tip is a complex zone for reconstruction. Numerous flap reconstructions have been proposed. In addition to the technique presented here, only the Gillies-Millard bishop’s miter flap and the paramedian forehead flap should be considered. The bilobed flap should be discontinued. The double-opposing V-Y flap for nasal tip reconstruction described here is an excellent method for reconstruction of limited defects of the nasal tip. These are mirror-image cutaneous flaps which require careful, skillful technique to preserve the delicate nerves and vessels. This challenging technique should only be attempted by qualified surgeons. Triangular cutaneous flaps are marked on either side of the defect, oriented transversely. The flaps are elevated and advanced with careful, gentle dissection. Ligamentous structures are cut while preserving the neurovascular supply. No cautery is used. The procedure is performed in an operating room with local anesthesia and with the patient under IV sedation. A patient who underwent this reconstruction is shown preoperatively, early postoperatively, and late postoperatively. The results demonstrate no tip distortion with imperceptible scars. The steps to undertake this procedure are outlined in detail. Rules for nasal tip reconstruction are proposed.

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“…They discuss the mobilization of the flap with strands of nasalis muscles bluntly dissected. 6 In 2017, La Padula et al 7 modified the nasalis flap by basing it on the superior muscle attachment, which they claimed allowed for a greater mobility of the flap.…”

Section: Introductionmentioning

confidence: 99%

Use of a Lateral Extended Nasal Island Flap for Nasal Reconstruction

Madorsky¹,

Ta²

2019

JAMA Facial Plast Surg

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IMPORTANCE Small and medium nasal defects of the nose have been treated mostly with local skin flaps and skin grafts producing variable aesthetic outcomes. The lateral extended nasal island (LENI) myocutaneous flap provides a reliable single-stage reconstruction for small to medium nasal defects, including those in the nasal tip, with excellent cosmetic results. OBJECTIVE To describe and define a new version of the lateral nasal island flap for small to medium nasal defects. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series included all patients who had undergone reconstruction with the lateral nasal island flaps and LENI flaps from October 2009 to July 2018 with 97 consecutive cases studied. Indications for surgery were mostly skin cancer defects. The analysis was performed from January 1, 2018, through December 15, 2018. MAIN OUTCOMES AND MEASURES The location and the size of the defects were defined. Number of stages required to achieve functional and aesthetic goals was reported. Appearance rating after the first stage was assessed. RESULTS The case series included 82 patients (mean age, 64 years [range, 31-90 years]; 36 [43%] women and 46 [57%] men). These 82 patients' flaps qualified as the LENI flap. Of these, 54 (65%) were used for nasal tip reconstruction. The flap advancing distance ranged from 0.7 cm to 1.8 cm (mean advancing distance, 1.2 cm). Of 67 patients with available postoperative photographic documentation, 44 had mild or undetectable signs of reconstruction, 21 had visible scars, and 3 had obvious deformities. A single-stage procedure was performed in 66 cases, 2 stages in 15 cases, and 3 stages in 2 cases. CONCLUSIONS AND RELEVANCE The LENI myocutaneous flap is a reliable technique for reconstruction of nasal defects up to 1.8 cm. The extended dissection and release of the flap at piriform aperture achieves the predictable outcome and separates it from the previously described lateral nasal island flaps. LEVEL OF EVIDENCE 4.

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

Cited by 6 publications

References 16 publications

Extended rotation flap for reconstruction of partial thickness defects of the tip and nasal ala region: in search of better aesthetic results

Extended rotation flap for reconstruction of partial thickness defects of the tip and nasal ala region: in search of better aesthetic results

V-Y Flap for Nasal Reconstruction

Use of a Lateral Extended Nasal Island Flap for Nasal Reconstruction

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