New Flap for the Reconstruction of the Perinasal Region

Abstract

Various reconstructive methods ranging from secondary healing to free flap applications are used for the reconstruction of perinasal defects caused by trauma or tumor surgery. The method to be used for the reconstruction of this region is chosen considering many factors because of specific determining structures. The number of studies on the subcutaneous tissue and vascular configurations of this region are gradually increasing along with the accumulation of knowledge in this region. Herein, we describe the nasal superficial musculoaponeurotic system–pedicled island skin flap for the reconstruction of the nasal tip, supratip, lateral nasal margin, and infraorbital area. The described skin flap was performed for defects resulting from basal cell carcinoma excision in all the patients. Of the patients, 12 were females and 5 were males. The mean age was 67.8 years (range, 56–82 years). All patients were operated on under general anesthesia. The flap donor areas were closed primarily. None of the patients developed flap necrosis. Although mild edema and venous insufficiency were observed in the flaps in the acute period only in patients who underwent nasal tip reconstruction, these improved during follow-up. In the operated patients, no problem was observed in the donor area and nasal dorsal skin. The nasal superficial musculoaponeurotic system–pedicled island skin flap which we describe for the perinasal area reconstruction is a safe, easily performed and versatile flap. The multidimensional use of this flap together with a relatively easy reconstruction plan and surgical procedure would be effective in flap choice.

Keywords

nasal reconstruction - SMAS flap - island skin flap

• References

• 1 Zitelli JA. Wound healing by secondary intention. A cosmetic appraisal. J Am Acad Dermatol 1983; 9 (3) 407-415
• 2 Wesley NO, Yu SS, Grekin RC, Neuhaus IM. Primary linear closure for large defects of the nasal supratip. Dermatol Surg 2008; 34 (3) 380-384 , discussion 384–385
• 3 Rieger RA. A local flap for repair of the nasal tip. Plast Reconstr Surg 1967; 40 (2) 147-149
• 4 Driscoll BP, Baker SR. Reconstruction of nasal alar defects. Arch Facial Plast Surg 2001; 3 (2) 91-99
• 5 Bayramiçli M. The distal dorsalis pedis flap for nasal tip reconstruction. Br J Plast Surg 1996; 49 (5) 325-327
• 6 Ulloa-Gregori AO, Montemayor-Jáuregui MC, Villarreal-Cárdenas JA, Garza-Mejía B. Use of the nasal SMAS to reconstruct defects of the tip, alae, columella, or septum. Plast Reconstr Surg 1999; 104 (3) 631-636
• 7 Erçöçen AR, Can Z, Emiroğlu M, Tekdemir I. The V-Y island dorsal nasal flap for reconstruction of the nasal tip. Ann Plast Surg 2002; 48 (1) 75-82
• 8 Maruyama Y, Iwahira Y. The axial nasodorsum flap. Plast Reconstr Surg 1997; 99 (7) 1873-1877
• 9 Antia NH, Daver BM. Reconstructive surgery for nasal defects. Clin Plast Surg 1981; 8 (3) 535-563
• 10 Letourneau A, Daniel RK. The superficial musculoaponeurotic system of the nose. Plast Reconstr Surg 1988; 82 (1) 48-57
• 11 Nakajima H, Imanishi N, Aiso S. Facial artery in the upper lip and nose: anatomy and a clinical application. Plast Reconstr Surg 2002; 109 (3) 855-861 , discussion 862–863
• 12 Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990; 13 (4) 227-236
• 13 Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol 1989; 125 (7) 957-959
• 14 Weber SM, Baker SR. Management of cutaneous nasal defects. Facial Plast Surg Clin North Am 2009; 17 (3) 395-417
• 15 Boyd CM, Baker SR, Fader DJ, Wang TS, Johnson TM. The forehead flap for nasal reconstruction. Arch Dermatol 2000; 136 (11) 1365-1370
• 16 Arslan E, Gencel E, Pekedis O. Reverse nasal SMAS-perichondrium flap to avoid supratip deformity in rhinoplasty. Aesthetic Plast Surg 2012; 36 (2) 271-277
• 17 Jewett BS. Repair of small nasal defects. Facial Plast Surg Clin North Am 2005; 13 (2) 283-299 , vi
• 18 Niranjan NS. An anatomical study of the facial artery. Ann Plast Surg 1988; 21 (1) 14-22