Ann Dermatol.  2014 Jun;26(3):377-380.

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

• Shim HC
• Kim G
• Choi JH
• Kim JH
• Kim EJ
• Park HJ
• Joh OJ
• Son SJ

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.

Keyword

Nasal cartilages; Surgical flaps

MeSH Terms

Aged
Carcinoma, Basal Cell
Cartilage*
Cheek
Female
Humans
Nasal Cartilages
Surgical Flaps
Transplants*

Figure

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  Fig. 1 Preoperative view. A 1.0×1.5 cm nodule on the right lateral ala.

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  Fig. 2 Histopathology showing basal cell carcinoma (H&E, ×40).

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  Fig. 3 Postoperative surgical defect (red arrow) and planned flap design. The base is placed more inferiorly and medially, and the proximal one-third of the flap was deepithelialized in advance (arrowhead).

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  Fig. 4 (A, B) Two years after the operation. The patency of the nostril is maintained well.

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  Fig. 5 Schematic diagrams of the reverse nasolabial flap showing turnover twice like a hinge. (A) Design; (B) Lining; (C) Coverage; (D) Final shape.

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