Recreating the alar crease following melolabial flap reconstruction of a full-thickness alar defect.

The nasal ala is a common site of cutaneous malignancy, and it is often deformed or resected during oncologic extirpation. (1) Local transposition flaps such as the bilobed flap are often used to close small (<1.5 cm) defects, but for larger defects and for those that involve vestibular lining, the melolabial or nasolabial flap is more appropriate. (2) Defects and flaps that involve the alar facial crease often result in blunting that may require later correction. In an effort to recreate the alar facial groove, a second stage procedure is performed as early as 6 to 8 weeks following surgery. Care must be taken to make incisions within the demarcations of the anatomic subunits and to create symmetry. The pedicle is divided and the flap is thinned of subcutaneous tissue. The edges of the incision are inverted and sewn to the subcutaneous tissue layer in an effort to recreate a sulcus. The small submillimeter gap between the edges is allowed to granulate and contract to further enhance sulcus formation.

A 66-year-old woman with history of facial skin cancers presented to the senior author (JRT) after she had undergone Mobs' chemosurgery for removal of a basal cell carcinoma on the right nasal ala (figure, A). A superiorly based melolabial flap was designed and executed to recreate an external and internal nasal lining (figure, B). A cartilage graft was also placed within the folded graft to augment lateral wall support. Postoperative closure was achieved, but the alar facial crease was blunted (figure, C). Six months after the initial procedure, the alar facial groove was recreated in the manner described earlier (figure, D). At the 1-year follow-up, the result was satisfactory (figure, E).

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References

(1.) Kopf AW. Computer analysis of 3531 basal-cell carcinomas of the skin. J Dermatol 1979;6:267-81.

(2.) Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol 1989;125:957-9.