Reconstruction of a Nasal Alar Defect, Paramedian Forehead Flap

Abstract

Reconstructive options for the nasal ala will depend upon the size of the defect, the depth, adjacent subunits involved, the amount of alar support, and the goals of the patient. Isolated defects of the ala are commonly repaired with full-thickness skin grafts or melolabial interpolation flaps. However, defects involving loss of the alar rim or vestibular mucosa are ideally reconstructed with a forehead flap. This also applies to large defects which extend beyond the alar subunit. Typically, this occurs with defects extending up the nasal sidewall or into the alar base of the melolabial region. The two unique concerns regarding this reconstruction are: (1) alar structure and support for the external nasal valve and (2) recreation of the alar groove.