Transposition Island Pedicle Flap to Repair the Nasal Ala

Reconstruction of the nasal ala presents surgical challenges, including loss of the nasofacial junction and vasculature compromise, in addition to achieving a cosmetically satisfactory result. The reconstructive surgeon has a variety of closure techniques to employ, but few allow for acceptable cosmesis in a single-stage procedure. The objective of this study is to discuss a novel approach to alar reconstruction using a melolabial-based transposition island pedicle flap, an alternative to traditional interpolated melolabial flaps and inferiorly based interpolated paranasal flap methods. Our reconstruction method utilizes an island pedicle flap harvested from the nasolabial fold and rotated 165˚ medially and superiorly into a surgical defect on the adjacent ala. The pedicle is placed within the alar facial sulcus for a slight trap-dooring effect, recreating the sulcus. The harvest site is closed linearly, resulting in a fusiform scar line to take advantage of the nasolabial fold. Although delicate care is required while dissecting and positioning the flap, it is an otherwise straightforward procedure. The ideal candidate for this technique presents with loss of the alar subunit with an intact alar rim. The only limitation to this style of flap is that the patient has undergone prior procedures involving the ipsilateral nasolabial fold. The transposition island pedicle flap is a well-tolerated alternative to patient cases that require grafting or more involved multi-step reconstructions to efficiently repair nasal alar defects. This technique provides the patient with a presentable cosmetic result using local tissue with minimal post-surgical complications and alar compromise.