USE OF A VERSATILE AXIAL DORSONASAL MUSCULOCUTANEOUS FLAP IN REPAIR OF THE NASAL LOBULE

We present our 17 years of experience in using a sliding axial musculo cutaneous flap from the nasal dorsum in the repair of 53 nasal lobular defects (follow-up 3 to 212 months, mean 47.3 months). This flap is a modification of the classic Rintala flap but is based on a greater un derstanding of surgical anatomy, the biomechanical properties of skin, and the physiology of flaps, all of which allow a more aesthetically satisfactory closure of very distal nasal lobular defects. After excis ing the tumor, two parallel incisions are made along the sides of the nasal dorsum, and the flap is raised in the gliding plane deep to the fibromuscular layer of the nose and superficial to the cartilage and b one and then advanced over the defect, which can be as large as the en tire nasal lobule. The flap is very reliable (no failure in our series ) and easy to perform; furthermore, it is a fast, one-step reconstruct ive procedure that leaves the scars in areas of natural shadow. This f lap makes use of a wide dorsal and glabellar undermining to recruit su fficient skin; it takes advantage of the mild tension exerted by the u nderlying nasal framework to lengthen the flap reliably without the ne ed for an extra incision or Burrow's triangles, as originally describe d by Rintala. Neither tip rotation nor glabella flattening has ever be en found to be a real problem in our series because the flap elongates in a period of 2 to 6 weeks and the tip always comes down, provided t hat the nasal framework is not modified. We believe that the axial mus culocutaneous sliding flap has distinct advantages over other alternat ive local flaps in the repair of lobular nasal defects; moreover, alth ough this simple operation cannot compete with the quality of the aest hetic results achieved by very skilled masters using frontal flaps, it is an easy, quick, one-step procedure that allows acceptable and reli able aesthetic results to be achieved by the majority of surgeons, and it does not harm the precious forehead donor site, which may become e ssential in case of the need for further reconstruction.