Nasolabial and Cheek Skin Flaps
R. R. CAMERON
The versatility and usefulness of the nasolabial flap are well known. If it is superiorly based for resurfacing of the nose, it should be based on the angular vessels and swung like a pendulum, rather than as a rotation flap, to avoid an excessive dog-ear. When used to resurface the tip of the nose, it is likely to result in a “biscuit-like” deformity that is best handled by excising the top surface of the flap tangentially and then covering it with a full-thickness skin graft. The nasal and cheek junction, which is an important landmark, is lost after use of this nasolabial flap.
Nasolabial and cheek skin flaps can be ideal sources for partial nasal reconstruction (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19). Exact duplication is impossible because of the unique features of the skin covering the nose: thin, resilient, and clear cephalad; thicker, less mobile, and sometimes with prominent pores and blood vessels caudally. The cheeks and forehead are the best color matches, and their proximity simplifies transfer. Flaps from both these areas can be developed in superficial planes so that bulk is diminished.
There is an area of relative redundancy that extends from the inner canthus of the eye to the inferior margin of the mandible, especially in older patients. Most smaller flaps are drawn from the outpouching of redundant tissue from the ala of the nose to the crura of the mouth. This area is generally free of hair growth, except for the lower cheek in males.
Medially, superiorly, and laterally based flaps are best used for reconstruction of the nose, while inferiorly based flaps lend themselves to transfer to the upper lip and nasal floor.
Flap tissue is necessary for coverage when there is a full-thickness defect of the nose or when bone or cartilage are exposed. Nasolabial cheek tissue can be used for coverage of defects of any part of the nose. The more cephalad portion, however, is usually best covered by forehead tissue.
Coverage of the lateral wall is often possible by direct advancement with wide undermining (Fig. 40.6) or by rotation of a subcutaneous pedicle flap from the nasolabial fold (see Chapter 44).
The alae of the nose also can be reconstructed using nasolabial flaps. Local turnover flaps or the addition of cartilage within the flap may be necessary for support. Narrow flaps may be used to reconstruct losses in the alar rim or to correct retraction of the rim, such as is seen with severe facial burns. The rim may be released and restored to its normal position, and the defect so created can be filled with a small nasolabial flap (Fig. 40.4).
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