THE IMPORTANCE OF MAINTAINING THE ALAR-FACIAL SULCUS IN NASAL RECONSTRUCTION

The alar-facial sulcus is an important topographical region because it represents a junctional zone of three cosmetic units: the nasal base, the medial aspect of the cheek, and the upper lip, Too often, the sul cus is violated by transposition flaps that have been harvested from t he cheek to reconstruct defects of the nasal-alar lobule. When the sul cus is violated by surgery, it is difficult to restore a completely na tural appearance. For this reason, we suggest an alternative method of reconstructing the alar lobule through the use of an interpolated fla p. When defects extend into the alar-facial sulcus, reconstruction of the sulcus is necessary and should be accomplished with a separate ski n flap from that used to repair the nasal component of the defect. Whe n a single flap is used to reconstruct both lobule and sulcus, restora tion of a completely natural-appearing sulcus is rarely achieved and u sually involves multiple surgical procedures often facilitated by aggr essive flap contouring, secondary intention healing, and Z-plasty, We describe our methodology in restoring the alar-facial sulcus after nas al reconstruction.