Abstract:

Objective   To discuss the methods and effects of large alar full-thickness defects reconstruction with combined application of island forehead flap and nasolabial flaps. Methods   We retrospectively reviewed the clinical and followup data in 4 patients who underwent singlestage reconstruction of large alar full-thickness defects with combined application of island forehead flaps and 2 nasolabial flaps from January 2008 to January 2011. All patients were male and the patients′ age ranged from 62 to 76 years, the mean age was 64 years, of which 3 cases of defects resulted from resection of skin malignant tumor (basal cell carcinoma in 2 cases, and acanthoma canceration in 1 case) and traumatic defect in 1 case.  The average diameter of defects was 3.3 cm (2.5-4.5cm).  Defects involved two subunits (tip + alar) in one case, three subunits (alar + tip+ nasal lateral side) in one case and four subunits (tip + alar + lateral side + dorsal) in 2cases. All patients had been excluded the risk factors of peripheral vascular disease. The first step, a trapezoidal flap of the medial nasolabial sulcus based on piriform aperture was harvested and turned into the nasal cavity to reconstruct the lining. Then the triangle flap of the lateral nasolabial sulcus was raised on a subcutaneous pedicle and was medially moved and sutured around the alar region. The third step, an island forehead flap, based on the subcutaneous pedicle containing the supratrochlear artery and the parallel terminal angular artery, was harvested and inferiorly transferred through the glabella subcutaneous tunnel to cover the nasal skin defect. Results   All defects were successfully repaired. All tissue flaps survived and the scar was not conspicuous. One patient had nostril stenosis with mild nasal congestion complain after the postoperatively 6th month. There was no tumor recurrence during 6 months to 3 year follow-up.   Conclusions   In select cases, the paramedian island forehead flap in combination with two nasolabial flaps can be safely used and is an effectively method to repair the large alar full thickness defect.

Key words: External nose; Skin cancer; Reconstructive surgical procedures; Island flaps; Alar full thickness defect