Reconstruction of an Alar Defect With a Fusiform Nasolabial Turnover Flap With a Proximal, Superiorly Tapered Apex

Abstract

The nasolabial turnover flap was first described by Spear et al in 1987 for the coverage of full thickness defects of the lateral ala. It offered a single-stage repair that recreated the internal nasal lining, the external nasal valve, and the rounded contour of the ala without requiring a cartilage graft. A frequently encountered problem with the execution of Spear's original design is elevation of the ipsilateral commissure of the adjacent lip due to its broad proximal pedicle. Here, the authors describe a fusiform-type design with a proximal, superiorly tapered apex that relies on anteriorly coursing perforators from the underlying angular artery. The authors also review the inherent advantages and disadvantages of the flap itself and the unique situation where there is a skin cancer adjacent to the donor site.

Modified Spear flap for the reconstruction of a full-thickness defect of the nasal ala

“…10 Again, the transfer of beard hairs from the cheek to the ala can occur in male patients, requiring laser epilation. 12 Finally, the internal nostril lining by skin and not by mucosa may need daily lubricant applications. 13 …”

“…A ‘tunneled’ turnover flap was performed to preserve a pre-existing alar groove if it was not lost during tumour removal. 9 , 12 Again, an elliptical or fusiform shaped flap with a proximal superiorly tapered apex has been shown to facilitate the donor site closure under minimal tension, avoiding a possible elevation of the ipsilateral upper lip, as may happen with the standard flap. 12 Although the Spear flap usually does not require cartilage supporting, a ‘valve’ phenomenon during inspiration may occasionally occur in some patients during surgery or even later.…”

“… 9 , 12 Again, an elliptical or fusiform shaped flap with a proximal superiorly tapered apex has been shown to facilitate the donor site closure under minimal tension, avoiding a possible elevation of the ipsilateral upper lip, as may happen with the standard flap. 12 Although the Spear flap usually does not require cartilage supporting, a ‘valve’ phenomenon during inspiration may occasionally occur in some patients during surgery or even later. 13 This complication requires correction with the insertion of a cartilage batten between the internal and external alar lining.…”

“…8-10 Some disadvantages, including excessive flap bulkiness with asymmetry of the nasal alae, lateral displacement of the nasal ala, and disappearance of lateral alar groove can take place with this technique. [8][9][10][11][12][13] Although they are usually of little concern, a second surgical procedure may be necessary in some cases to refine the flap and improve the cosmetic outcomes. 10 Again, the transfer of beard hairs from the cheek to the ala can occur in male patients, requiring laser epilation.…”

“…10 Again, the transfer of beard hairs from the cheek to the ala can occur in male patients, requiring laser epilation. 12 Finally, the internal nostril lining by skin and not by mucosa may need daily lubricant applications. 13 Various modifications of the original Spear flap have been later reported for better functional and aesthetic results, especially in particular cases.…”