Tunneled island flaps in facial defects reconstruction

Abstract

The reconstruction of facial surgical defects is usually challenging for the dermatologic surgeon. Three different cases of facial defects in which tunneled island flaps were used are reported. In 2 cases, wide defects involving the nasal dorsum and ala were repaired using a nasolabial island flap tunneled through the lateral side of the nose. A tunneled island glabellar flap was used for medial canthus reconstruction in the third case. Despite complex pedicle dissection and frequent trapdoor deformation, tunneled island flaps allow reconstruction of wide defects in a single-staged procedure, camouflaging the scar of the donor area in boundaries of cosmetic units and preserving the facial central symmetry.

Tunneled Interpolated Flaps in the Reconstruction of Nasal Defects

“…3 It is necessary to measure correctly the pedicle and to compensate the shortening caused while mobilizing and tunneling the flap. 11 Attention must also be payed to the height of the anterior hairline and degree of forehead skin laxity. 3 The origin of the supratrochlear artery is consistently found to be 1.7 to 2.2 cm lateral to the midline, and the artery exits the orbit by piercing the orbital septum.…”

“…However, this effect usually improves with time and rarely needs correction. 11,12 Injections of triamcinolone acetonide may accelerate this natural regression. 9 Fourth, tunneled flaps are also prone to trapdoor effect, 11 particularly when they are relatively bulky with round borders 12 (Fig.…”

“…Reducing the flap size in 20% to 25% as compared with the primary defect, suturing in a way as to lower the flap below the surrounding skin and undermining extensively the borders of the receptor area are techniques to help minimizing this problem. 11,12 Intralesional steroid injection can also help to correct this deformity.…”

“…Of note, the risk of trapdoor effect of tunneled flaps can actually be beneficial when recreating the round shape of the ala nasi. 11,15…”

Reconstruction of the Nose: Management of Nasal Cutaneous Defects According to Aesthetic Subunit and Defect Size. A Review

“…A subtle trap-door deformity does not require any specific treatment besides frequent massaging; this should confirm the lymphatic impairment behind the etiology of this complication [49,50]. The second-line conservative treatment is triamcinolone injections.…”