V-Y Bipedicle Flap for Resurfacing The Nasal Supratip Region
For resurfacing the nasal supratip region, use of the V-Y bipedicle flap allows the concealment of the lower incisions in the normal alar creases and of the upper incisions in the glabellar folds (1).
The supratip area of the nose lies between the tip area and the nasal dorsum, overlying the septal angle of the cartilaginous septum. Supratip nasal skin has a distinctive texture, contour, and color. Techniques used for resurfacing this area include skin and composite grafts and local and distant flaps (1, 2, 3, 4, 5, 6, 7). If the incisional lines are so placed as to be hidden in the natural creases, a local flap would appear to be the most satisfactory choice, since it provides for restoration of both normal contour and skin color.
FIGURE 38.1 A: Outline of supratip excision, with high V planned, beginning in the glabellar area. B: Bipedicle flap mobilized and shifted distally. Distal tip is elevated to meet the leading edge of the flap. C: Closure of defects. (From Strauch, Fox, ref. 1, with permission.)
FLAP DESIGN AND OPERATIVE TECHNIQUE
The lesion in the supratip area is marked for appropriate excision. Two lateral triangular areas are then drawn to the nasolabial folds, defining an elliptical defect, the lower borders of which conform to the upper borders of the alar crease. A V is then planned, starting high in the glabellar area, coming down the side of the nose, and extending out on the cheek in the border between the cheek and the eyelid skin (Fig. 38.1A).