Superiorly based nasalis myocutaneous island pedicle flap with bilevel undermining for nasal tip and supratip reconstruction

BACKGROUND. Superiorly based naps with bilevel undermining for the reconstr uction of nasal tip and supratip defects have not been utilized to this poi nt for reconstruction of this cosmetic subunit. OBJECTIVE. The purpose of this presentation is to describe a new flap for t he reconstruction of nasal tip and supratip defects and to introduce a new method of undermining-bilevel undermining-in the raising of these naps. METHODS. In this presentation we demonstrate (diagrammatically and with fre sh cadaver dissection) the methods of preparing, raising, and preforming th is new flap. We further introduce and describe the concept of bilevel under mining. RESULTS. We describe the first author's 4-year experience in the developmen t of this flap. We show clinical representative cases with pre- and postope rative results. CONCLUSIONS. Superiorly based myocutaneous island pedicle naps with bilevel undermining, a new method of nasal tip and supratip reconstruction, yields excellent functional and cosmetic results. Bilevel undermining is a new an d valuable method of achieving greater tissue mobility in muscle-based flap s.