The subcutaneous melolabial island flap for nasal alar reconstruction: A clinical review with nuances in technique

Authors

  • Richard L. Arden MD, FACS,

    Corresponding author
    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, William Beaumont Hospital, Troy, Michigan, U.S.A.
    • MD, FACS, Lakeshore Ear, Nose, Throat, PC, 11080 Hall Road, Suite A, Sterling Heights, MI 48314
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  • George S. Miguel DO

    1. Department of Otolaryngology–Facial Plastic Surgery, Henry Ford Macomb Hospital, Clinton Township, Michigan, U.S.A.
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To describe our experience with surgical reconstruction of whole subunit nasal alar skin losses following Mohs ablative surgery, using a subcutaneous melolabial island flap with emphasis on a simplified technique to minimize facial scarring and optimize facial contour.

Study Design:

Retrospective review of case series.

Methods:

A single surgeon's results in 48 consecutive patients spanning 7 years were analyzed by comprehensive chart review. Details of wound site and flap-specific complications were noted. Favorable nuances in surgical technique differing from standard approaches are graphically described.

Results:

Loss of melolabial sulcal depth was the most commonly seen donor-site complication (8%). No cases of flap compromise were seen. An unexpectedly high frequency of subjective nasal obstruction was seen (37%) after the second stage, more common when cartilage grafts were underutilized, and with through-and-through defects at inception. External contour was uniformly good to excellent.

Conclusions:

The described variation in subcutaneous melolabial island flap transfer provides reliable soft tissue replacement for whole subunit alar skin losses with favorable donor-site scarring and resultant contour. Attention to proper utilization of supportive cartilage grafts and ancillary debulking procedures is often necessary to optimize functional outcomes. Laryngoscope, 2012

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