BACKGROUND: Alar reconstruction can be challenging, and numerous solutions for reconstructing this potentially difficult area have been proposed. The authors' preferred solution is an island inversion flap based on the superior alar artery. METHODS: The authors performed a retrospective review of the medical notes and photographs of 103 consecutive patients who underwent alar reconstruction with the nasal sidewall island inversion flap. Patient demographics and complications were recorded. When they were available, postoperative photographs (>2 months postoperatively) were rated by three plastic surgeons using a Likert scale together with a rating guide to determine the aesthetic outcome. RESULTS: Between 1998 and 2012, the authors performed 103 island inversion flaps. Mean patient age was 59 years (range, 23 to 85 years). Eighteen (17 percent) of 103 patients had defects extending beyond the ala. There were no flap losses and seven cases of superficial epidermolysis. Revision surgery was performed in three cases. In 48 of 103 cases, postoperative photographs (>2 months postoperatively) were available for aesthetic assessment. The aesthetic results were rated as "good" to "excellent" in more than 70 percent of cases (range, 73 to 85 percent) by the three plastic surgeons. CONCLUSIONS: The nasal sidewall island inversion flap is a reliable and versatile flap for alar reconstruction. It can consistently produce good to excellent aesthetic results in a single-stage operation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: Alar reconstruction can be challenging, and numerous solutions for reconstructing this potentially difficult area have been proposed. The authors' preferred solution is an island inversion flap based on the superior alar artery. METHODS: The authors performed a retrospective review of the medical notes and photographs of 103 consecutive patients who underwent alar reconstruction with the nasal sidewall island inversion flap. Patient demographics and complications were recorded. When they were available, postoperative photographs (>2 months postoperatively) were rated by three plastic surgeons using a Likert scale together with a rating guide to determine the aesthetic outcome. RESULTS: Between 1998 and 2012, the authors performed 103 island inversion flaps. Mean patient age was 59 years (range, 23 to 85 years). Eighteen (17 percent) of 103 patients had defects extending beyond the ala. There were no flap losses and seven cases of superficial epidermolysis. Revision surgery was performed in three cases. In 48 of 103 cases, postoperative photographs (>2 months postoperatively) were available for aesthetic assessment. The aesthetic results were rated as "good" to "excellent" in more than 70 percent of cases (range, 73 to 85 percent) by the three plastic surgeons. CONCLUSIONS: The nasal sidewall island inversion flap is a reliable and versatile flap for alar reconstruction. It can consistently produce good to excellent aesthetic results in a single-stage operation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.