Nasalis Musculocutaneous Sliding Flaps for Nasal Tip Reconstruction
F. J. RYBKA
Projecting like a masthead from the surface of the face, the nasal tip is subjected to more than its share of skin cancers and trauma. Subcutaneous sliding flaps, including V-Y flaps, have been described for reconstruction of a great number of areas about the face, almost to the exclusion of the nasal tip (1, 2, 3, 4, 5, 6, 7). These flaps are generally based on a random-pattern subcutaneous blood supply, unlike the flap described herein.
INDICATIONS
The alar flap has some aesthetic advantages over vertical flaps, in that it follows the lines of the alar groove, the natural crease line leading to the tip. Also, most tip lesions are not squarely midline, but paramedian, and they are usually reconstructed using a lateral flap (Fig. 45.1).
ANATOMY
The facial muscles are unique in human anatomy, in that they have as their insertion the skin of the face. This insertion may be more aponeurotic than muscular, as it is with the nasalis muscle.
The nasalis muscle originates, with several other facial muscles, from a common fibrous band in the nasolabial fold. As it approaches the alar groove, the nasalis muscle is separated from the skin by subcutaneous fat, but as it continues medially toward the tip (as an aponeurosis), it becomes intimately associated with the dermis of the tip skin, with no layer of subcutaneous fat in between.
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