Richard L Arden1, George S Miguel. 1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, William Beaumont Hospital, Troy, Michigan, USA. richardlarden@aol.com
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.
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.