Partial reconstruction of a nose based on a nasolabial flap after the resection of a squamous cell carcinoma involving the nasal septum, columella, and upper lip

INTRODUCTION: Reconstruction of complex facial defects is a challenge for surgeons. After the excision of a lesion, nasal reconstruction is challenging because of the variety of tissues involved and the reduced local donor area for reconstruction. On the other hand, a major difficulty in the reconstruction of lip lesions is restoration of function, with the priority being the maintenance of the integrity of the sphincter structure, oral continence, mouth opening, and sensitivity. Among the alternatives for the reconstruction of these areas are local flaps, including the nasolabial flap. AIM: To analyze the outcome of nasal and upper lip reconstruction performed in two surgical stages, by using a nasolabial flap for complex defects resulting from the resection of squamous cell carcinoma (SCC). CASE REPORT: A 56-year-old female patient presented with advanced SCC in the nasal region of the columella, anterior third of the septum, and part of the upper lip. She underwent reconstruction with a nasolabial flap and, in a second surgical procedure, with a costal cartilage graft for the reconstruction of the columella. The procedures resulted in good integration and viability of grafts and flaps. The aesthetic result was satisfactory. CONCLUSION: The use of a nasolabial flap as a therapeutic option for the partial reconstruction of the nose and upper lip produces favorable functional and aesthetic outcomes. In addition, the division of the surgical procedure into stages provides safety in the use of local flaps, particularly in patients with poor healing. INTRODUCAO: Reconstrucoes de defeitos complexos na face constituem um desafio para os cirurgioes. Apos resseccao da lesao, o reparo nasal e dificil, ja que possui uma variedade de tecidos e area local doadora reduzida para reconstrucao. Ja as lesoes de labio possuem como principal dificuldade a restauracao da funcao, priorizando a integridade da estrutura esfincteriana, a continencia oral, a abertura bucal e a sensibilidade. Entre as alternativas para reconstrucao dessas areas, podemos optar por retalhos locais, entre os quais o nasogeniano. OBJETIVO: Analisar desfechos de reconstrucao nasal e de labio superior em dois tempos cirurgicos, utilizando retalho nasogeniano, apos defeito complexo causado por resseccao de carcinoma espinocelular (CEC). RELATO DO CASO: Paciente do genero feminino, 56 anos, apresentou CEC de progressao avancada em regiao nasal da columela, terco anterior do septo e parte do labio superior. A paciente foi submetida a reconstrucao com retalho nasogeniano e, em segundo momento cirurgico, ao enxerto de cartilagem costal para reconstrucao de columela. Apresenta evolucao com boa integracao e viabilidade dos enxertos e retalhos. O resultado estetico foi satisfatorio. CONCLUSAO: A utilizacao de retalho nasogeniano como opcao terapeutica para a reconstrucao parcial de nariz e de labio superior apresentou desfechos funcionais/esteticos favoraveis. Alem disso, a segmentacao do procedimento cirurgico traz seguranca na utilizacao dos retalhos locais, principalmente em individuos de dificil cicatrizacao.