The Subcutaneous Pedicle Nasolabial Flap-A Modified Technique for Midface Reconstruction

Background:Nasolabial flaps have long been used to reconstruct the midfacial defects because of their proximity and matching of skin texture. However, when performing a pedicle nasolabial flap, it is always necessary to disrupt borders that separate aesthetic regions or it necessitates second stage operation for pedicle division if it crosses over them.Aim and Objectives:We described a series of nasolabial flap procedures to illustrate how the modified technique can improve the results of midface reconstruction.Materials and Methods:From November 2003 to February 2012, nasolabial flaps in the modified technique were used for midface reconstruction in 12 patients. The facial defects were on the upper lip in four cases, the cheek in one case and the nose in seven cases. All of the skin and soft tissue defects resulted from radical resection of basal cell carcinoma and squamous cell carcinoma except one on the upper lip of a young male after removal of an unsightly scar.In the reconstructive procedure, we made the flap as a subcutaneous pedicle island flap that reached the facial defect through a subcutaneous tunnel. Surgery using a 5:1 length-to-width ratio from the pivot point to the tip of the flap was safely performed without compromising the circulation of the flap. A subcutaneous tunnel was made between the pivot point of the flap and the defect to keep the skin intact, thereby preserving the nasofacial boundaries and facial subunits.Results:Twelve patients, 6 males and 6 females with an average age 64 years, underwent midface reconstruction with nasolabial flap using the modified technique. All flaps survived completely without loss or donor site morbidity. All patients had satisfactory results with only an inconspicuous scar on the donor site.Conclusion:Performing nasolabial flap procedure for midface reconstruction using the modified technique offers the advantages of preservation of facial topography in a one stage operation while avoiding dog ear formation which can develop in cutaneous pedicle nasolabial flap. This durable nasolabial flap has a large length to width ratio, a big arc of rotation, a superiorly or inferiorly based pedicle and minimal donor site morbidity.