The use of folded melolabial interpolation flaps to repair full thickness distal nasal defects: A review of technique and results
Abstract
The nose is a common site for skin cancer and there are several surgical options available for reconstruction after excision. Traditional surgical teaching suggests that in the case of a partial full thickness defect involving the distal nose or ala, a paramedian forehead flap (PMFF) or an intranasal lining flap with free cartilage graft and additional cutaneous flap should be performed. However, each of these options comes with unique disadvantages. The incision and pedicle required for the PMFF can be unsightly and functionally limiting, while the intranasal lining flap is technically challenging and can obstruct the nostril. Herein, we review our experience with a two-stage folded-over melolabial interpolation flap (MLIF) to repair partial full thickness defects of the distal nose and ala in order to recreate the cutaneous covering, nasal rim, and inner mucosal lining.
References
Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population, 2012. JAMA Dermatol 2015; 151(10): 1081–1086. doi: 10.1001/jamadermatol.2015.1187.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66(1): 7–30. doi: 10.3322/caac.21332.
Evans GR, Williams JZ, Ainslie NB. Cutaneous nasal malignancies: Is primary reconstruction safe? Head Neck 1997; 19(3): 182–187. doi:10.1002/(SICI)1097-0347(199705)19:3<182::AID- H¬E¬D3>3.0.CO;2-Z.
Baker SR, Swanson NA. Management of nasal cutaneous malignant neoplasms. An interdisciplinary approach. Arch Otolaryngol 1983; 109(7): 473–479. doi: 10.1001/archotol.1983.00800210049012.
Borah GL, Rankin MK. Appearance is a function of the face. Plast Reconstr Surg 2010; 125(3): 873–878. doi: 10.1097/PRS.0b013e3181cb613d.
Rankin M, Borah GL. Perceived functional impact of abnormal facial appearance. Plast Reconstr Surg 2003; 111(7): 2140–2146. doi: 10.1097/01.PRS.0000060105.63335.0C.
Menick FJ. A new modified method for nasal lining: The Menick technique for folded lining. J Surg Oncol 2006; 94(6): 509–514. doi: 10.1002/jso.20488.
Menick FJ. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plast Reconstr Surg 2002; 109(6): 1839–1861. doi: 10.1097/00006534-200205000-00010.
Singh DJ, Bartlett SP. Aesthetic considerations in nasal reconstruction and the role of modified nasal subunits. Plast Reconstr Surg 2003; 111(2): 639–651. doi: 10.1097/01.PRS.0000041602.85239.93.
Yoon T, Benito-Ruiz J, García-Díez E, Serra-Renom JM. Our algorithm for nasal reconstruction. J Plast Reconstr Aesthet Surg 2006; 59(3): 239–247. doi: 10.1016/j.bjps.2005.09.035.
Baker SR. Local flaps in facial reconstruction. St. Louis: Mosby Elsevier; 2007. p. 732.
Driscoll BP, Baker SR. Reconstruction of nasal alar defects. Arch Facial Plast Surg 2001; 3(2): 91–99.
Arden RL, Nawroz-Danish M, Yoo GH, Meleca RJ, Burgio DL. Nasal alar reconstruction: A critical analysis using melolabial island and paramedian forehead flaps. Laryngoscope 1999; 109(3): 376–382. doi: 10.1097/00005537-199903000-00007.
Baker SR, Naficy S. Principles of nasal reconstruction. St. Louis: Mosby; 2002.
Burget GC, Menick FJ. Nasal support and lining: The marriage of beauty and blood supply. Plast Reconstr Surg 1989; 84(2): 189–202. doi: 10.1097/00006534-198908000-00001.
Yellin SA, Nugent A. Melolabial flaps for nasal recon-struction. Facial Plast Surg Clin North Am 2011; 19(1): 123–139. doi: 10.1016/j.fsc.2010.10.010.
Maher IA, Garrett AB, Rausch C. Use of thermoplastic bandaging material as a templating medium for the design of interpolation flaps for nasal repair. Dermatol Surg 2012; 38(5): 791–792. doi: 10.1111/j.1524-4725.2012.02366.x.
Fisher GH, Cook JW. The interpolated paranasal flap: A novel and advantageous option for nasal-alar reconstruction. Dermatol Surg 2009; 35(4): 656–661. doi: 10.1111/j.1524-4725.2009.01106.x.
Somoano B, Kampp J, Gladstone HB. Accelerated takedown of the paramedian forehead flap at 1 week: In-dications, technique, and improving patient quality of life. J Am Acad Dermatol 2011; 65(1): 97–105. doi: 10.1016/j.jaad.2011.01.019.
Fader DJ, Baker SR, Johnson TM. The staged cheek- to-nose interpolation flap for reconstruction of the nasal alar rim/lobule. J Am Acad Dermatol 1997; 37(4): 614– 619.
Copyright (c) 2016 Maher E, et al.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Author(s) shall retain the copyright of their work and grant the Journal/Publisher rights for the first publication with the work concurrently licensed under the Creative Commons Attribution-Noncommercial 4.0 International License
Under this license, author(s) will allow third parties to download, reuse, reprint, modify, distribute and/or copy the content under the condition that the authors are given credit and that the work is not used for commercial purposes. No permission is required from the authors or the publisher.
This broad license intends to facilitate free access, as well as the unrestricted use of original works of all types. This ensures that the published work is freely and openly available in perpetuity.