Objective To evaluate the effectiveness of the dermal pedicled nasolabial flap with subdermal vascular network for repairing nasolabial skin defects. Methods Between July 2008 and July 2011, 43 cases of nasolabial defects wererepaired with dermal pedicled nasolabial flap with subdermal vascular network. There were 22 males and 21 females with a median age of 36 years (range, 6-68 years). All defects were caused by excision of lesions, including pigmented nevus in 23 cases, scar in 16 cases, and inflammatory granuloma in 4 cases. The disease duration was 3 months to 35 years. Lesions were located at the tip of the nose in 11 cases, at the alae of the nose in 10 cases, at the alae and tip of the nose in 10 cases, at the alar groove of the nose in 8 cases, and at upper l ip in 4 cases. The defect size ranged from 0.7 cm × 0.5 cm to 1.2 cm × 1.0 cm. The flap size ranged from 1.0 cm × 0.7 cm to 1.5 cm × 1.2 cm. Results All flaps survived and incisions at donors and wound healed by first intention. After operation, 34 patients were followed up 6-12 months (mean, 10 months). The texture and color of the flap were similar to adjacent skin. No obvious scar was observed at donor sites. Conclusion The dermal pedicled nasolabial flap with subdermal vascular network has the advantages of flexible flap transplantation, small damage to donor site, and low incidence of bloated subcutaneous tunnel.
ObjectiveTo investigate the feasibility of the extended nasolabial flap in repairing small or medium anterior buccal mucosal defects. MethodsBetween March 2013 and April 2014, 10 patients with anterior buccal mucosal defects were treated with extended nasolabial flaps. There were 8 males and 2 females with the average age of 47.2 years (range, 39-62 years). The left side was involved in 4 cases and the right side in 6 cases. The pathological types included 3 cases of oral leukoplakia (OLK), 3 cases of OLK with malignant changes, 1 case of malignant oral lichen planus, and 3 cases of papilloma. The clinical course ranged from 2 to 15 months (mean, 7.1 months). The resection was restricted to the mucosa and little buccinators without cheek penetration, and the defects ranged from 2.5 to 4.0 cm in width and 3.5 to 5.5 cm in length. The distance between defect and the corner of the mouth was 0.5 to 1.5 cm. A falcate flap was designed along the nasolabial fold with a pedicle lateral beside the corner of the mouth. The flap was lifted in the plane of the superficial muscular aponeurotic system from both terminal points to the region of the central pedicle. Then the flap was transposed intraorally through a transbuccal tunnel to cover the mucosal defect while the extra-oral incision was closed directly. ResultsAll flaps completely survived and all wounds healed primarily. All patients were followed up 6 to 18 months (mean, 10.4 months). All patients regained symmetrical appearances and normal mouth commissure only with linear scars hidden in the nasolabial folds. The mouth opening was 2.7 to 3.5 cm (mean, 3.1 cm) at last follow-up. The intraoral flaps healed perfectly with thin and flat outlooks. No cheek biting or fish-mouth deformity was observed. ConclusionThe extended nasolabial flap can be used to repair small or medium anterior buccal mucosal defects because it has the advantages of reliable blood supply, flexibility in design, simplicity in harvesting, and hidden donor site scars.
Objective To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose. Methods The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm. ResultsOne patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any “cat ear” malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction.ConclusionThe bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.
Objective To investigate the approach of using a nasolabial flap in conjunction with an auricular composite tissue flap with the skin on the dorsal aspect of the auricle excised for the restoration of full-thickness defects of the nasal ala following the removal of basal cell carcinoma. Methods The data of unilateral nasal alar full-thickness defect after basal cell carcinoma surgery at Department of Plastic and Burn Surgery of West China Hospital, Sichuan University between January 2016 and January 2018 were selected. All patients had full-thickness defects of the unilateral nasal ala after surgery. According to the size of the defect, the nasal labial sulcus flap combined with the auricular composite tissue flap with the skin on the back of the auricle removed was used for nasal ala repair and reconstruction in the first stage. The pedicle division of the flap was performed in the second stage one month after the surgery. The observation contents included: the survival situation of the flap and the auricular composite tissue flap, the recurrence situation of the tumor, the appearance of the affected nasal ala, the scar situation in the surgical area, and the patient satisfaction. Results A total of 18 patients were included. Among them, there were 5 males and 13 females. All 18 patients were followed up for 36 months postoperatively. The postoperative flaps and auricular composite tissue flaps survived favorably, and no tumor recurrence was detected. The contour of the affected nasal ala was satisfactory, the surgical scars were inconspicuous, and the nasofacial angle was effectively maintained. All patients expressed satisfaction with the appearance of the nose and the facial profile. Conclusions The two-stage surgical repair protocol involving the use of a nasolabial flap in combination with an auricular composite tissue flap with the skin on the back of the auricle removed for repairing the full-thickness defect of the nasal ala after basal cell carcinoma of the nasal ala is straightforward in execution. It can yield a favorable nasal ala appearance postoperatively and adequately safeguard the nasofacial angle from impairment. Thus, it merits extensive application and promotion.