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muscle&#44; and skin&#41;&#44; as this will considerably reduce the options for reconstruction&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Local intranasal flaps with re-epithelization of the secondary defect are very useful for repair of the mucosal plane&#44; but the technique is laborious&#46; Mucoperichondrial flaps from the nasal septum&#44; wall&#44; or conchae have the added advantage of providing cartilaginous support&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Cartilage grafts from the septum&#44; helix&#44; or costal cartilage&#44; combined with local flaps are an excellent option&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Finally&#44; the use of inert alloplastic materials&#44; such as titanium or polyethylene mesh&#44; can be a good alternative&#44; particularly in large defects&#44; but none of these materials is free of risks such as necrosis&#44; infection&#44; or extrusion&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the case presented&#44; after considering all possible options&#44; and in an attempt to minimize their aforementioned drawbacks&#44; we decided to use a myochondromucosal rotation flap from the adjacent ala combined with an ipsilateral melolabial flap&#46; The procedure can be seen in the video&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was a 79-year-old woman in whom a recurrent basal cell carcinoma was fully excised after 2 stages of Mohs micrographic surgery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> A&#41;&#46; The lesion infiltrated the lateral wall of the nose and a large part of the ala&#44; with full-thickness involvement of the central part of the ala &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> B&#41;&#46; The size of the overall defect created was 2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#59; the central full-thickness defect measured 1<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1&#46;2<span class="elsevierStyleHsp" style=""></span>cm&#46; Closure was performed using a myochondromucosal rotation flap from the whole of the adjacent ala combined with an ipsilateral melolabial flap&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">When creating the myochondromucosal flap&#44; we had to ensure that there was an adequate pedicle to avoid necrosis&#46; After rotation onto the area of the tip of the nose&#44; the borders were fixed with an absorbable 4&#47;0 polyglycolic acid suture&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">When creating the skin flap&#44; we had to consider not only the length to width ratio&#44; in order to avoid necrosis&#44; but also its thickness&#44; in order to achieve an acceptable cosmetic result and avoid the very undesirable trap-door effect&#46; After resection and adjustment&#44; the tip of the skin flap was sutured with 4&#47;0 silk&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The functional and cosmetic result 8 weeks after the operation was excellent &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0045" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Reconstruction of partial&#44; full-thickness defects of 1 to 1&#46;5<span class="elsevierStyleHsp" style=""></span>cm in diameter affecting the alar and perialar regions of the nose&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0055" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Very small full-thickness defects in which cartilage repair is not necessary or when the defect can be closed by direct suture&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Very large defects in which there is insufficient adjacent tissue to cover the defect&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0025">Risks</span><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Infection&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Postoperative chondritis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Trap-door effect&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Retraction of the ala&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Unsightly scarring&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Alternatives</span><p id="par0100" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Free cartilage grafts from the ear&#44; nasal septum&#44; or ribs&#59; these are more laborious techniques with a high risk of necrosis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0110" class="elsevierStylePara elsevierViewall">Alloplastic materials &#40;titanium or polyethylene mesh&#41;&#46; Experience is necessary with these materials&#46; There is a risk of infection&#44; extrusion of the material&#44; or a trap-door effect&#44; which would require reoperation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">Inverted melolabial flap&#59; this does not provide cartilage support&#46;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">Although chondromucosal flaps from the adjacent ala and the melolabial flap are extensively described in the literature&#44; the combination of the 2 flaps has not previously been reported&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We present this combined flap as an excellent option for the reconstruction of partial&#44; full-thickness defects of the alar and perialar regions of the nose&#46; This method of reconstruction offers cartilaginous support without the need for alloplastic materials and with a lower risk of necrosis than other options&#46; This simple and original technique is performed in a single operation under local anesthesia and will stimulate the creative capacity of the dermatologic surgeon&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Valladares-Narganes L&#44; Gonz&#225;lez-Sixto B&#44; Otero-Rivas M&#44; Rodr&#237;guez-Prieto M&#46; Colgajo mio-condro-mucoso de rotaci&#243;n combinado con colgajo de trasposici&#243;n melo&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;821&#8211;823&#46;</p>"
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