Nasolabial Skin Flap for Columellar Reconstruction
F. X. PALETTA SR.
Reconstruction of the nasal columella using a variety of techniques including composite grafts and skin flaps have been described. Total columellar reconstruction requires a large volume of soft tissue that can be obtained through the use of an adjacent skin flap. A technique that is immediate, has a good color match, takes a small amount of time, and results in minimal scarring is the nasolabial flap.
Composite grafts from the outer helix of the ear have been used in columellar reconstruction, but they are best used for partial defects (1, 2, 3). Composite grafts are also limited because the tissue bed for columellar reconstruction is usually scarred or absent, thereby compromising the availability of a well-vascularized bed for adequate composite graft take. Various flaps have been described to lengthen the columella, especially in the bilateral cleft lip nasal deformity patient (4, 5, 6). When there is a complete loss of the columella, however, with exposure of the nasal septum, it is necessary to use a skin flap.
Tubed pedicle flaps from the neck and arm have been used successfully in the past. However, multiple stages are required to obtain the final result, and the flaps from these staged procedures tend to remain too thick and bulky in this region. The forehead flap is an excellent choice in total and partial nasal reconstruction, and it can also be useful in reconstruction of the columella. However, when the only defect is in the columella, the forehead flap is not the best first choice because of the distance of the flap from the defect and the potential wasted portion of the flap necessary in the transfer. The most accessible region for reconstruction of the columella alone is the nasolabial area (7). It provides an abundant amount of adjacent tissue with a good color match, and can easily be done under local anesthesia.
See Chapter 40.