L-shaped Design of the Thenar Eminence Perforator Free Flap for Total Reconstruction of the Nasal Ala

We introduce and evaluate a novel L-shaped perforator free flap from the thenar eminence for total nasal ala reconstruction, addressing both the inner and outer linings in complex nasal reconstruction cases. A 74-year-old man with a history of basal cell carcinoma and multiple failed local flap reconstructions underwent nasal ala reconstruction using the L-shaped thenar flap. The flap, based on the superficial branch of the radial artery, was designed to create a 3-dimensional nasal structure, and its viability was ensured using intraoperative Doppler monitoring. The L-shaped thenar flap successfully reconstructed the nasal ala, maintaining the shape and function of the nostril. The robust vascularization and the ability to incorporate structural cartilage minimized the risk of flap failure. The donor site morbidity was minimal, and the aesthetic outcome was satisfactory, with the flap providing adequate tissue for both the internal and external nasal linings. The L-shaped thenar flap is a viable and effective option for complex nasal ala reconstruction, offering reliable vascularization, sufficient tissue for comprehensive reconstruction, and minimal donor site complications. This technique provides a promising alternative for challenging nasal reconstructions, eliminating the need for separate cutaneous islands and allowing for the potential inclusion of a structural cartilage layer.