The versatile naso-labial flaps in facial reconstruction

Surgical excision of tumors from the face may create a defect that is difficult to restore. Skin grafts can only cover superficial defects and has a natural tendency to contract and may not take properly. Also, because of the colour mismatch, it is not cosmetically identical to the face. The use of regional flaps such as the median forehead flaps are usually bulky, can not cover a wide range of facial reconstruction and usually require the donor area to be grafted. The naso-labial flaps are very useful and versatile local flaps, with robust vascularity that can be readily elevated without a delay. The flap can be superiorly based to reconstruct defects on the cheek, side wall or the dorsum of the nose, alae, collumula and the lower eye lid. Inferiorly based flaps can be used to reconstruct defects in the upper lip, anterior floor of the mouth and the lower lip. The flap can be turned over and used as a lining of the nose and the lip.

In the current study we present our experience with utilization of the nasolabial flaps in facial reconstruction. We evaluated the indications, flap designs, technique, and complications. We will also assess the final functional and aesthetic results.

The study included 20 patients (12 males and 8 females) presented at the surgical department, National Cancer Institute (NCI) Cairo University with skin cancer at different areas of the face. Preoperative assessment includes. Assessment of the stage of the disease, the flap design and patient general condition.

The mean age of the patients was 56.3 +/-6 years (range 16-62 years). Fifteen patients presented with basal cell carcinoma, 2 squamous cell carcinoma, one malignant melanoma, one keratoacanthoma, and one xeroderma pigmentosa. Nasal defects constituted 75% of cases, the rest were lower eye lid (2), one upper lip and one oral commisure beside a case of cheek reconstruction. There was no major complication; only one patient suffered a reactionary hemorrhage that required re-exploration to secure the bleeder. A single procedure was adequate in most of the patients (80%), only 4 patients required revision of the scar at the donor site. The overall aesthetic results were very satisfactory in the majority of patients (16), and satisfactory in 2 cases. Only 2 patients were not satisfied by the final aesthetic results, one suffered from ectropion and the other had a donor site wound healing problem.

The nasolabial flap is a versatile, simple, easy to harvest local flap that can cover a variety of defects in the face. It is ideally suitable for covering small and moderate sized defects in the eye lid, cheek, nose, the anterior floor of the mouth and the lip.