Caterpillar Nasal Skin Flap for Nasal Tip Reconstruction
T. D. CRONIN
This is a two-stage operation to restore the projection of the tip of the nose. The advanced flap is bunched up just above the scar, and in a second procedure, the extra skin is brought down to resurface the scar. It is not clear whether or not this procedure is applicable to freshly excised wounds. The tip of the nose also can be resurfaced with a local “banner” flap, and projection of the tip can be obtained with a cartilage graft, if necessary.
Small losses of the nasal tip may be repaired by a caterpillar flap, which consists of a V-Y advancement as the first stage (1).
The caterpillar flap is suitable for repairing small losses of the nasal tip. If nasal lining is required, this method would probably not be adequate unless small flaps could be turned in from the margins for lining. Thick, sebaceous, or excessively scarred nasal skin might be too thick or stiff to fold properly.
The blood supply to this flap follows a random pattern. Blood supply of the skin of the nose is very robust and survives on narrow and even scarred pedicles.
A triangular flap is elevated, taking care to carry the apex no higher than or only slightly higher than the inner canthi to avoid difficulties in closure owing to fixation of the skin at the latter points. The flap is advanced downward and folded onto itself. A shift of 1 to 1.5 cm can be accomplished readily.