IDEAS AND INNOVATIONS
Single-stage reconstruction of alar defect of the nose
by subcutaneous island nasolabial and remnant alar flap
Devendra Kumar Gupta
Received: 17 April 2014 /Accepted: 27 June 2014 / Published online: 12 August 2014
Springer-Verlag Berlin Heidelberg 2014
Abstract A single-stage technique for reconstruction of the
medial nasal ala with a nasolabial flap and an inferiorly based
remnant alar flap is presented in this article. The technique has
been used in four cases. All the flaps healed uneventfully with
aesthetically pleasing results using the one-stage technique.
The subcutaneous nasolabial island flap and alar remnant flap
have become the method of choice in the author’sclinicfor
partial medial nasal ala reconstruction. It allows one-stage
reconstruction with very similar tissue and a concealed scar
in the natural groove. The remnant ala as an inferiorly based
flap has been used by the author to cover the subcutaneous
pedicle of the nasolabial flap to provide better shape to the alar
base without its lateral drift during healing.
Level of Evidence: Level V, therapeutic study.
Keywords Alar flap
Medial alar defect
Loss ala nose
Flaps for repairing combined skin and lining defects of the ala
of the nose using nasolabial flaps in single stage have been
described by Pers and Spear [1, 2]. In these similar techniques,
the nasolabial flap has been used to provide both lining and
cover for total alar defect by giving a twist to this flap.
In the techniques of the abovementioned authors, the re-
construction of the complete loss of the ala has been demon-
strated. However, the cases where part of the alar base was
intact have not been included. Usually in both techniques,
secondary operations for thinning of the flaps and medial
shifting of laterally dragged alar base are required.
The technique herein presented is different from the previ-
ous ones for reconstruction of medial alar defects. This tech-
nique always uses an alar flap from the remnant alar base even
if the skin is scarred. This alar flap binds the reconstructed ala
at its original position, whereas in other techniques, the base of
the ala is drifed posterolaterally.
The length of the nasolabial flap is calculated after measuring
the width of the defect of the ala. It usually is twice the width
of the alar defect added to the width of the alar remnant. It is
recommendable to add 5–7 mm of extra length to compensate
the length lost in turning and twisting the flap.
Cases are commonly operated under the combination of
regional anesthesia. The tip of the nose, ala, upper lip, and
infra-orbital area are anesthetized by bilaterally blocking
infraorbital and external nasal nerves. However, the operation
can also be executed under general anesthesia.
The nasolabial flap is marked along the nasolabial groove.
The most medial part of the flap is de-epithelized according to
the width of the remnant of the ala. The nasolabial flap is
dissected with 3–4 mm of subcutaneous tissue attached to it.
An appropriate size of the subcutaneous tissue is kept at the
base to randomly vascularize the flap. The inferiorly based
hinged alar flap is turned down and defect margins are fresh-
ened. The nasolabial flap is turned medially and stitched to the
nasal lining. After completion of the nasal lining, the redun-
dant nasolabial flap is turned up to provide the cover of the
defect with natural alar margin.
The inferiorly based hinged alar flap was turned down. The
defect margins were freshened. The nasolabial flap was turned
medially and stitched to the nasal lining. After completion of
D. K. Gupta (*)
Devendra Hospital and Yuva Cosmetic Clinic, 55 Prabhat Nagar,
Bareilly 243122, UP, India
Eur J Plast Surg (2014) 37:555–558