Nostril alar rim threshold flap for columellar reconstruction

The reconstruction of the columella poses a significant challenge to the plastic surgeon. A multitude of techniques have been developed to address this issue; however, the end result is often unsatisfactory or comes at too high a morbid cost. Gillies described an alar margin flap in 1949 that never gained significant popularity. This technique had been refined by Servant over the past two decades in his work on Noma noses in Africa. We describe a two-stage columella reconstruction technique with a nostril alar rim threshold flap and provide the results of our case series. Under local anaesthesia, a full-thickness alar flap is raised by placing an incision along the alar-facial groove and carrying it around the lateral crus. This flap is then rotated on its medial pedicle and inserted into the nasal tip. Three weeks after the first stage, the flap is divided to the desired columellar length and the remaining ala relocated to the alar-facial groove. At the same time, the contralateral ala can be adjusted to match the donor side. We performed a retrospective study of all our columellar reconstructions using this local flap. Our case series consisted of seven patients, and satisfactory cosmetic results were obtained in all cases. The nostril alar rim threshold flap is a useful technique for columellar reconstruction, producing near-anatomic results that can be performed as a two-stage outpatient procedure under local anaesthesia. This technique is particularly well suited for columellar reconstruction in patients of African descent.