A-T Flap for Reconstruction of Nasal Dorsum Skin Defects

Abstract

Reconstruction of nasal defects can be challenging, especially when encountering larger defects. We describe the use of a single-stage conversion of an ‘A’ shaped defect to a ‘T’ shaped scar of large nasal skin defects in the cosmetically sensitive supra-tip and supra-alar regions. This study aimed to determine whether an A-T flap is a suitable option for nasal reconstruction and if so where and what size defects it can be used for. Retrospective case series review over an 8-year period (2011–2019) in a tertiary referral center in the United Kingdom. Case analysis was undertaken in 2020 including all patients who underwent A-T reconstruction of nasal defects. A review of histology, case notes, and clinical photography was undertaken. A total of 27 patients were identified—13 (48%) female and 14 (52%) male. The median age was 73 years (range 31–90 years). Defect locations were supra-tip (48%) and supra-alar (52%). The largest defect closed was 895 mm² (30 × 38 mm). Range 35 to 895 mm² (median 264 mm²). No patient required revision or corrective procedures. No functional impairment was identified. Patient and clinician reported aesthetic outcomes as good in all cases. No reports of this technique could be identified in the literature. The A-T flap is a viable option for supra-tip and supra-alar skin defects (up to 895 mm² in our series). It aligns well with the basic principles of nasal reconstruction. The flap can be performed under local anesthesia in one stage, resulting in good functional and aesthetic outcomes and so can be considered a valuable tool for the nasal reconstructive surgeon.

Keywords

facial plastics - nasal reconstruction - rhinology - aesthetics

Publication History

Article published online:
28 November 2023

• References

• 1 Cox A, Fort M. Nasal reconstruction involving multiple subunit defects. Facial Plast Surg 2017; 33 (01) 58-66
• 2 Menick FJ. Principles and planning in nasal and facial reconstruction: making a normal face. Plast Reconstr Surg 2016; 137 (06) 1033e-1047e
• 3 Moses HA, Woodard CR. Update on reconstructive options for nasal Mohs defects 1.5 cm or less. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (04) 300-308
• 4 Al Deek NF, Wei FC. It is the time to say good bye to the reconstructive ladder/lift and its variants. J Plast Reconstr Aesthet Surg 2017; 70 (04) 539-540
• 5 Tardy Jr ME. Alternatives in nasal reconstruction (“five flaps and a graft”). Laryngoscope 1976; 86 (12) 1824-1827
• 6 Spataro E, Branham GH. Principles of nasal reconstruction. Facial Plast Surg 2017; 33 (01) 9-16
• 7 Watkinson JC, Clarke RW. eds. Scott-Brown's Otorhinolaryngology and Head and Neck Surgery: Volume 3: Head & Neck Surgery, Plastic Surgery. United Kingdom: CRC Press; 2018
• 8 Stiegel E, Leach B, Albertini JG. Mohs micrographic surgery pearls for the nose and lips. Dermatol Surg 2019; 45 (Suppl. 02) S99-S109
• 9 Newlove T, Trufant JW, Cook J. The bilateral dufourmentel flap for repair of nasal dorsum defects after Mohs micrographic surgery. Dermatol Surg 2016; 42 (03) 320-326
• 10 Kouwenhoven ST, van Kester MS, Genders RE. The wingman flap: bilateral closure of a supra-tip defect of the nose. J Am Acad Dermatol 2017; 76 (02) e57-e58
• 11 Lu GN, Kriet JD, Humphrey CD. Local cutaneous flaps in nasal reconstruction. Facial Plast Surg 2017; 33 (01) 27-33
• 12 Bohne AS, Dunsche A, Kaeding M. The combination of the Wilson bridge flap with A-T advancement flap for extensive red lip defects and defects of the skin of the lip. J Dtsch Dermatol Ges 2021; 19 (01) 147-150
• 13 Stevens CR, Tan L, Kassir R, Calhoun K. Biomechanics of A-to-T flap design. Laryngoscope 1999; 109 (01) 113-117
• 14 Burget GC, Menick FJ. Aesthetic Reconstruction of the Nose. St Louis: Mosby; 1994
• 15 González-Ulloa M. Regional aesthetic units of the face. Plast Reconstr Surg 1987; 79 (03) 489-490