Nasolabial Flap Variations and Alternatives in Nasal Ala Reconstruction

Different nasolabial flap variations have been advocated, including two-staged and single-staged flaps. However, when to choose which variation remains unclear. The performance of nasolabial flap variations was analyzed and compared to other reconstructive options. Consecutive alar reconstructions performed during a 10-year period (2012 - 2022) were studied retrospectively. Patient charts were reviewed for defect size, reconstructive technique, cartilage grafts, surgical complications, and secondary procedures. Patients were followed-up clinically at 3, 6 and 12 months. Aesthetic outcomes were evaluated using standard digital photographs. 148 alar reconstructions were performed in 84 female and 64 male patients (mean age, 69 years). Average defect diameter was 1.6 cm (range, 0.5 - 4.5 cm). 110 reconstructions (74%) were performed with nasolabial flaps, 90 single-staged and 20 two-staged, including 68 nasolabial-cheek flaps, 32 nasolabial island flaps and 10 nasolabial transposition flaps. 38 reconstructions (26%) employed other flaps in 20, skin-fat grafts in 14, and direct closure in 4 cases respectively. Alar rim grafts (95 primary and 5 secondary) were used in 100 patients. Complications occurred in 43 patients (29%), including hematoma, delayed wound healing, flap necrosis, vestibular stenosis and alar crease obliteration. Planned secondary procedures were performed in 20 nasolabial island flaps and 12 paramedian forehead flaps. Unplanned secondary procedures were performed in 40 single-stage (44%) and 2 two-stage (10%) nasolabial flaps, respectively. None of the other single-stage flaps or skin-fat grafts were revised. Single-stage nasolabial flaps produce aesthetically pleasing results and compare favorably to other techniques. However, unplanned secondary surgery is frequent.