New Design Concept of Nasolabial Flap for the Reconstruction of a Complex Defect in the Alar Base

When relatively large tumors are excised in the alar base, the skin defect region may extend into the nasal alar, surrounding buccal region, and upper labial region. Because the alar base is a complex three-dimensional shape, a satisfying esthetic outcome with a conventional nasolabial flap alone for the reconstruction of the skin defect is difficult to achieve. We proposed a new nasolabial flap design concept for the reconstruction of such complex skin defects. This concept clearly divides the flap composition sites into three corresponding sites in the defect region. This report gives an outline of our proposed flap design.

The tissue defect region is divided into the following three sites: (A) nasal alar, (B) buccal, and (C) upper labial ([Fig. 1]). Our concept of flap's design clearly divides the flap composition sites into three corresponding sites in the defect region ([Fig. 2]). The flap is initially divided into two sides, the cranial and caudal sides, with the nasolabial groove as the center. On the cranial side of the defect site, to reconstruct the nasal alar, the flap region A is first designed. Then, to reconstruct the buccal tissue defect, the flap region B is designed as a large arc on the cranial side of the nasolabial groove continuing on from the flap region A. Finally, to reconstruct the upper labial tissue defect, the flap region C is designed to be placed on the caudal side of the nasolabial groove. The flap is elevated between the zygomaticus major and zygomaticus minor muscles while carefully dividing the flap pedicle to move the flap without tension to the skin. For flap suturing, the flap region A is folded back to cover the nasal alar defect, after which the flap regions A and B are carefully sutured to restore a three-dimensional shape transitioning from the buccal region to the nasal alar. Finally, the flap region C is appropriately trimmed to fit the defect size and then used to cover the upper labial defect ([Fig. 3]). We applied this technique in three patients, and no patient had complications. Esthetically satisfactory outcomes were achieved for all patients.

Fig. 1 The tissue defect is divided into three sites: (A) nasal alar, (B) buccal, and (C) upper labial.

Fig. 2 The concept of the flap's design divides the flap composition sites into three corresponding sites in the defect region.

Fig. 3 This is an appearance after flap suturing. An esthetically satisfactory outcome could be achieved.

The nasolabial flap was described as a pedicle flap with a subcutaneous based mainly inferiorly on branches of the facial artery. Then the superiorly and inferiorly based variants have been well described in the literature. Now, we developed a new type of nasolabial flap with a clearer flap design concept to enable the reconstruction of complex defect sites with a single flap. This concept clearly divides the flap composition sites into three corresponding sites in the defect region. The advantage of our flap is that the clarity of the flap design makes it easy for anyone to use. We believe that this flap can enable the effective reconstruction of complex tissue defects in the alar base.

Publication History

Article published online:
12 April 2021