Restoration of Large Skin Defect on Nose Dorsum using Nasalis Island Pedicle Flap with Bilevel Undermining

Kim, Ji Seok; Choi, Misoo; Nam, Chan Hee; Kim, Jee Young; Hong, Seung Phil; Kim, Myung Hwa; Park, Byung Cheol

Abstract

Reconstruction of defects on the lower third of the nose is always a challenge, as dissection of tissues in this area is not simple due to both a lack of elasticity and the structural complexity of the mid-facial area. When the defect size is less than 1.5 cm on the nose, primary closure or a bilobed flap is widely-used, while a skin graft is required for reconstruction of larger defects. Here we present two cases of a nasalis myocutaneous island pedicle flap with bilevel undermining with a relatively large nasal dorsum defect (>2 cm). The nasalis myocutaneous island pedicle flap with bilevel undermining was performed in order to maximize the movement of skin flaps and minimize the secondary movement of flaps after surgery. The nasal tip showed a slight upward movement immediately after surgery that subsequently moved down to a normal level. This technique can be utilized for reconstruction of the lower part of the nose for defects 2 cm or larger in size by maximizing the movement of the flap within the nasal structure. A major advantage is a higher flap survival rate due to proper arterial supply and the procedure results in relatively reduced secondary motion of the flap after the surgery.