Para-alar crescentic subcutaneous pedicle flap for
severe stenosis of anterior nares
Yoshio Yamawaki, MD
Division of Plastic and Reconstructive Surgery, Kyoto-Katsura Hospital, Kyoto, Japan
Received 16 June 2005
Abstract Atresia and stenosis of the anterior nares caused by scar contracture is one of the intractable conditions
that may arise after facial injury. Using the standard surgical methods, such as mucous membrane and/
or skin graft and intranasal local flap, the new nostril has a tendency to restenose. Para-alar crescentic
subcutaneous pedicle flap, which was intended to cover the skin defects in and around the philtrum,
was applied to treat severe stenosis of the nostril caused by scar contracture. The procedure resulted in
improvement of nasal obstruction with satisfactory postoperative appearance of the external nose.
This article presents an operative technique using this flap for severe stenosis of anterior nares.
D 2006 Elsevier Inc. All rights reserved.
Atresia and stenosis of the anterior nares caused by scar
contracture is one of the intractable conditions that may
arise after facial injury. Various procedures, such as mucous
membrane graft, skin graft [1,2], intranasal local flap [3-6],
and other techniques, have been applied to the stenosis,
followed by prolonged use of prosthetic support to maintain
the caliber of the anterior nares [2,3,5]. The new nostril,
reconstructed by these usual procedures, remains likely to
restenose, especially in severe cases.
Para-alar crescentic subcutaneous pedicle flap described
by Suzuki  in 1989 was intended to cover the skin defects
in and around the philtrum. This local flap has abundant
blood supply and the scar at the donor site is almost invisible.
This article presents an operative technique using bpara-
alar crescentic subcutaneous pedicle flapQ for severe stenosis
of the anterior nares.
2. Surgical procedure and case reports
After opposing Y-shaped incision of the lesion, the scar
contracture is released until symmetric nostril contour is
obtained. The crescentic subcutaneous pedicle flap is then
designed according to the defect of the nasal floor. The
cross-sectional area of the pedicle is much the same as the
area of the crescentic flap. The subcutaneous pedicle is
carefully undermined until the flap is transferred to the
defect without much tension. The flap is moved with 158 to
208 of rotation. Any remaining scar tissue is then
additionally excised and the flap sutured. The donor site is
then closed in the alar fold (Fig. 1). A small gauze pack is
left in the nostril for 2 days. In addition, as a stent, a nos-
tril retainer made by silicone rubber is inserted and worn
24 hours per day for about 2 or 3 months to prevent post-
operative contracture. One or two months after the proce-
dure, the inelastic, firm, bulkiness caused by subcutaneous
0196-0709/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
4 Division of Plastic and Reconstructive Surgery, Kyoto-Katsura
Hospital, 17 Yamada- Hirao, Nishikyo, Kyoto 615-8256, Japan. Tel.: +81
75 391 5811; fax: +81 75 381 0090.
E-mail address: YFA57136@nifty.com.
Fig. 1. Schematic presentation of procedure. (A) Opposing Y-shaped
incision of the lesion. (B) Design of the crescentic subcutaneous pedicle
flap. (C) Immediate postoperative appearance. Arrow indicates defect of the
floor of nostril; F, crescentic flap; SP, subcutaneous pedicle.
American Journal of Otolaryngology– Head and Neck Medicine and Surgery 27 (2006) 211 – 213