The Reverse Nasolabial Flap with a Cartilage Graft for the Repair of a Full-Thickness Alar Defect: A Single-Stage Procedure

Abstract

A 65-year-old woman with a deeply infiltrating basal cell carcinoma in the right ala underwent full-thickness excision of most of the ala, including the alar rim, crease, and the adjacent cheek, leaving a 'through-and-through' defect. Reconstruction was performed by using the reverse nasolabial flap and a cartilage graft across the alar defect, harvested from the concha, to prevent nostril collapse and to maintain the alar shape. The reverse or turnover nasolabial flap is a variant of the conventional nasolabial flap; however, it may be more suited for the repair of a full-thickness, lateral alar defect. The reverse nasolabial flap functions both as an inner liner and an outer cover and the repair is performed as a single-stage procedure. Furthermore, this flap can provide both excellent function and excellent cosmetic outcome.

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

“… 12 Finally, the internal nostril lining by skin and not by mucosa may need daily lubricant applications. 13 …”

“… 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. 13 It has been reported with the use of the standard Spear flap and never with the ‘tunneled’ variant.…”

Hybrid reconstruction of distal nasal defects

“…Local tissues, such as the nose, cheeks, forehead, and periauricular areas, are considered suitable for the restoration of nasal defects, but long‐term unsatisfactory results may still occur because of collapses, depressions, or contractures of the soft tissues, unless they have been supported with adequate cartilage framework as precaution 6‐9 . Most of the single‐stage operations (if not all) to repair full‐thickness lateral alar defects such as the shark island pedicle flap, nasolabial flap, reverse nasolabial flap, tunneled transposition flap, composite cartilage, skin graft, or a combination of these techniques share common disadvantages, such as lining the ala by the skin rather than by mucosa, lack of structural support, and possible lateral displacement of the alar rim 7‐12 . Although ipsilateral or contralateral septal mucoperichondrium flaps can be alternatives for the mucosal lining to the inner sites of the flaps and for providing structural support with cartilage grafts, these flaps may disrupt the native intranasal anatomy.…”

“…[6][7][8][9] Most of the single-stage operations (if not all) to repair full-thickness lateral alar defects such as the shark island pedicle flap, nasolabial flap, reverse nasolabial flap, tunneled transposition flap, composite cartilage, skin graft, or a combination of these techniques share common disadvantages, such as lining the ala by the skin rather than by mucosa, lack of structural support, and possible lateral displacement of the alar rim. [7][8][9][10][11][12] Although ipsilateral or contralateral anatomy. Additionally, their donor sites may not be suitable or large enough to cover the whole area, especially in cases with previous trauma or surgery.…”

Modification of classic reconstructive techniques and evaluation of new esthetic methods in terms of the expectations of modern oto-rhino-laryngology and head-neck surgery

“…Since then several modifications of the method have been described depending on the size and localization of the defect (44)(45)(46).…”