Case and Research Letters
Reconstruction of the Ala Nasi Using a Malar Turnover Island Pedicle Flap
Reconstrucción del ala nasal mediante colgajo malar invertido de pedículo subcutáneo
E. Godoy-Gijón
, L. Palacio-Aller, M. González-Sabin
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Servicio de Dermatología, Hospital de Cabueñes, Gijón, Asturias, Spain
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Godoy-Gijón, L. Palacio-Aller, M. González-Sabin" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Godoy-Gijón" "email" => array:1 [ 0 => "dra.e.godoy@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Palacio-Aller" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "González-Sabin" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital de Cabueñes, Gijón, Asturias, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción del ala nasal mediante colgajo malar invertido de pedículo subcutáneo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1473 "Ancho" => 2501 "Tamanyo" => 510335 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Outcome. A, Immediate outcome after suture of the flap. B, Outcome at 3 weeks after the intervention.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma is a rapidly growing tumor that can cause local damage and also has metastatic potential. Reconstruction of the nasal pyramid is a challenge for the surgeon as not only should functionality be maintained but the esthetic impact should also be minimized.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 97-year-old woman who attended our clinic with a very painful, fast-growing tumor, first noted 4 months earlier. The lesion, on the left nasal ala, was an ulcerated tumor and measured 3.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4.5<span class="elsevierStyleHsp" style=""></span>cm in its longest diameter (Figure 1). Biopsy confirmed the suspected diagnosis of squamous cell carcinoma and surgical excision was indicated.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The entire nasal ala was excised under local anesthetic, with a 5<span class="elsevierStyleHsp" style=""></span>mm margin, including the mucosal and cartilaginous layers as well as the tissue adjacent to the upper lip and left malar region (Figure 1B). Given that most of the nasolabial fold had been excised, it was decided to use a malar turnover island pedicle flap for reconstruction.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The design of the skin island flap aligned the upper edge with the upper border of the mucosal defect. The lower half of the flap was marked out to reflect the length of the nasal skin defect. The pedicle of the flap was dissected below the subcutaneous cell tissue, such that it retained a diameter of at least 1.5<span class="elsevierStyleHsp" style=""></span>cm and its base was located in the most proximal part of the surgical defect (Figure 2A), retracting the subcutaneous tissue from the base of the rest of the flap. After turnover of the island, the mucosal defect was sutured with resorbable material (Figure 2A [arrow] and B). A guide suture (single 4-0 silk stitches) was used along the edge of the nasal ala. After layer closure of the defect of the upper lip and the malar area using an advancement flap, the flap was folded onto the nasal ala and the skin defect was reconstructed. The flap was cut to adapt it to the defect and sutured (Figure 3) with single stitching with nonresorbable material (4-0 silk). A transfixion suture was used for the alar flap to facilitate its complete coaptation and avoid ischemia. Antibiotic prophylaxis was prescribed and anterior nasal packing was applied with a compressive dressing for the first 48<span class="elsevierStyleHsp" style=""></span>h.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The postoperative period was satisfactory, with no complications. The stiches were removed 7 days after the operation. The nasal cavity did not collapse and good ventilatory function was maintained (Figure 3B).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Complete reconstruction of surgical defects in the nasal ala is often encountered in everyday surgical practice. Traditional use of the nasolabial fold is not practical in cases in which the surgical defect includes this region. In 1987, Spear et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> reported a variation of the nasolabial flap in which the flap was inverted, maintaining the subcutaneous pedicle. The turnover malar flap of the subcutaneous pedicle is a variant of this procedure and extremely useful when the surgical defect includes the nasolabial fold.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the design, the cutaneous island should be adjusted to the size of the defect. The width should be the same as the horizontal size of the region to be reconstructed. The length should be at least twice that of the defect to enable mucosal and cutaneous reconstruction. The pedicle should be cut to a depth of 2-3<span class="elsevierStyleHsp" style=""></span>mm at the level of the subcutaneous cellular tissue. The distal three-quarters of the pedicle should be freed from the underlying tissue, with only one-quarter remaining anchored.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Excess fatty tissue in the island should be removed to improve the esthetic result.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> It is recommended to prescribe antibiotic prophylaxis both intraoperatively and postoperatively in these patients.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The complications are those inherent in all flap interventions. Necrosis is generally caused by an insufficiently large or twisted pedicle. The trap door effect may not necessarily occur if the fatty material is removed from the flap. It should be remembered that there may be facial hair on the nasal pyramid, and this could be avoided by leaving out hair-covered areas when designing the cutaneous island.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A major limitation lies in the absence of cartilaginous structure or support, which would not only improve the esthetic outcome, but would also prevent collapse with inspiration. This could be overcome by adding a free cartilage graft from the concha of auricle<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5,6</span></a> or a titanium mesh,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> although such procedures were considered unnecessary in this case given the age of the patient. Other reconstruction options requiring a single intervention are nasolabial transposition flap or subcutaneous turnover pedicle,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,7</span></a> but these are not useful in this case because the surgical defect would include this region.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Reconstructive surgery was performed in a single intervention of the nasal ala and perialar region, using a malar turnover island pedicle flap. The functional and esthetic outcomes were good. This technique is a very useful tool for the reconstruction of large defects in the nasal ala with involvement of the nasolabial fold, which rules out use of this structure for the flap design.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Godoy-Gijón E, Palacio-Aller L, González-Sabin M. Reconstrucción del ala nasal mediante colgajo malar invertido de pedículo subcutáneo. Actas Dermosifiliogr. 2015;106:233-235.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1637 "Ancho" => 2501 "Tamanyo" => 724920 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Squamous cell carcinoma in the left nasal ala. A, Lesion prior to surgical excision. B, Surgical defect after excision of the tumor.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1440 "Ancho" => 1666 "Tamanyo" => 339931 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Reconstruction. A, Design of the flap, showing the cut of the subcutaneous pedicle (*) and suture of the turnover island (arrow). B, Schematic of the flap.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1473 "Ancho" => 2501 "Tamanyo" => 510335 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Outcome. A, Immediate outcome after suture of the flap. B, Outcome at 3 weeks after the intervention.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new twist to the nasolabial flap for reconstruction of lateral alar defects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.L. Spear" 1 => "S.S. Kroll" 2 => "S. 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"serieFecha" => "2012" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alar batten cartilage grafting in nasal reconstruction: Functional and cosmetic results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.R. Byrd" 1 => "C.C. Otley" 2 => "T.H. Nguyen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2000.107740" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "833" "paginaFinal" => "836" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11050589" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of a full thickness alar wound with a single operative procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.L. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 11 | 21 |
| 2024 Octubre | 145 | 62 | 207 |
| 2024 Septiembre | 152 | 43 | 195 |
| 2024 Agosto | 153 | 95 | 248 |
| 2024 Julio | 141 | 52 | 193 |
| 2024 Junio | 104 | 41 | 145 |
| 2024 Mayo | 108 | 38 | 146 |
| 2024 Abril | 97 | 29 | 126 |
| 2024 Marzo | 137 | 41 | 178 |
| 2024 Febrero | 167 | 35 | 202 |
| 2024 Enero | 107 | 33 | 140 |
| 2023 Diciembre | 82 | 17 | 99 |
| 2023 Noviembre | 112 | 27 | 139 |
| 2023 Octubre | 109 | 22 | 131 |
| 2023 Septiembre | 130 | 30 | 160 |
| 2023 Agosto | 83 | 26 | 109 |
| 2023 Julio | 99 | 41 | 140 |
| 2023 Junio | 83 | 23 | 106 |
| 2023 Mayo | 93 | 29 | 122 |
| 2023 Abril | 70 | 13 | 83 |
| 2023 Marzo | 74 | 27 | 101 |
| 2023 Febrero | 48 | 26 | 74 |
| 2023 Enero | 61 | 32 | 93 |
| 2022 Diciembre | 73 | 44 | 117 |
| 2022 Noviembre | 42 | 32 | 74 |
| 2022 Octubre | 38 | 18 | 56 |
| 2022 Septiembre | 50 | 27 | 77 |
| 2022 Agosto | 36 | 32 | 68 |
| 2022 Julio | 36 | 31 | 67 |
| 2022 Junio | 28 | 20 | 48 |
| 2022 Mayo | 54 | 30 | 84 |
| 2022 Abril | 47 | 30 | 77 |
| 2022 Marzo | 50 | 48 | 98 |
| 2022 Febrero | 36 | 28 | 64 |
| 2022 Enero | 55 | 28 | 83 |
| 2021 Diciembre | 40 | 29 | 69 |
| 2021 Noviembre | 51 | 48 | 99 |
| 2021 Octubre | 88 | 59 | 147 |
| 2021 Septiembre | 50 | 40 | 90 |
| 2021 Agosto | 70 | 38 | 108 |
| 2021 Julio | 73 | 36 | 109 |
| 2021 Junio | 52 | 32 | 84 |
| 2021 Mayo | 37 | 25 | 62 |
| 2021 Abril | 102 | 55 | 157 |
| 2021 Marzo | 76 | 20 | 96 |
| 2021 Febrero | 57 | 32 | 89 |
| 2021 Enero | 36 | 26 | 62 |
| 2020 Diciembre | 41 | 15 | 56 |
| 2020 Noviembre | 34 | 17 | 51 |
| 2020 Octubre | 22 | 13 | 35 |
| 2020 Septiembre | 24 | 12 | 36 |
| 2020 Agosto | 21 | 16 | 37 |
| 2020 Julio | 23 | 16 | 39 |
| 2020 Junio | 33 | 22 | 55 |
| 2020 Mayo | 23 | 21 | 44 |
| 2020 Abril | 38 | 17 | 55 |
| 2020 Marzo | 33 | 19 | 52 |
| 2020 Febrero | 3 | 0 | 3 |
| 2019 Diciembre | 3 | 4 | 7 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Octubre | 0 | 6 | 6 |
| 2019 Septiembre | 4 | 10 | 14 |
| 2019 Agosto | 2 | 8 | 10 |
| 2019 Julio | 0 | 8 | 8 |
| 2019 Junio | 3 | 15 | 18 |
| 2019 Mayo | 0 | 26 | 26 |
| 2019 Abril | 0 | 24 | 24 |
| 2019 Marzo | 7 | 7 | 14 |
| 2019 Febrero | 7 | 3 | 10 |
| 2019 Enero | 3 | 2 | 5 |
| 2018 Diciembre | 3 | 7 | 10 |
| 2018 Noviembre | 6 | 0 | 6 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Mayo | 0 | 10 | 10 |
| 2018 Marzo | 3 | 1 | 4 |
| 2018 Febrero | 30 | 6 | 36 |
| 2018 Enero | 54 | 5 | 59 |
| 2017 Diciembre | 56 | 6 | 62 |
| 2017 Noviembre | 31 | 6 | 37 |
| 2017 Octubre | 31 | 7 | 38 |
| 2017 Septiembre | 23 | 4 | 27 |
| 2017 Agosto | 20 | 10 | 30 |
| 2017 Julio | 19 | 4 | 23 |
| 2017 Junio | 33 | 18 | 51 |
| 2017 Mayo | 21 | 21 | 42 |
| 2017 Abril | 20 | 9 | 29 |
| 2017 Marzo | 17 | 35 | 52 |
| 2017 Febrero | 30 | 8 | 38 |
| 2017 Enero | 25 | 10 | 35 |
| 2016 Diciembre | 29 | 13 | 42 |
| 2016 Noviembre | 37 | 15 | 52 |
| 2016 Octubre | 34 | 17 | 51 |
| 2016 Septiembre | 0 | 10 | 10 |
| 2016 Agosto | 0 | 1 | 1 |
| 2016 Julio | 9 | 1 | 10 |
| 2016 Junio | 9 | 2 | 11 |
| 2016 Mayo | 6 | 1 | 7 |
| 2016 Abril | 6 | 11 | 17 |
| 2016 Marzo | 2 | 2 | 4 |
| 2016 Febrero | 10 | 9 | 19 |
| 2016 Enero | 7 | 10 | 17 |
| 2015 Diciembre | 4 | 10 | 14 |
| 2015 Noviembre | 6 | 7 | 13 |
| 2015 Octubre | 5 | 1 | 6 |
| 2015 Septiembre | 0 | 1 | 1 |
| 2015 Agosto | 0 | 2 | 2 |
| 2015 Julio | 5 | 3 | 8 |
| 2015 Junio | 2 | 1 | 3 |
| 2015 Mayo | 3 | 4 | 7 |
| 2015 Abril | 0 | 12 | 12 |
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