Two-stage delayed and prelaminated nasolabial flap for nasal reconstruction

Reconstruction of nasal defects involving the alar region, nasal tip, and lateral nasal wall remains challenging because restoration of contour continuity, structural support, and airway patency must be achieved simultaneously. This study evaluated the clinical outcomes of a two-stage delayed and prelaminated nasolabial flap designed to improve vascular reliability and long-term contour stability in nasal reconstruction.

A total of 22 patients underwent nasal reconstruction following excision of basal cell carcinoma or squamous cell carcinoma. Defects included both full-thickness and complex partial-thickness nasal defects. The surgical technique combined flap delay, dermo-subcutaneous prelamination with conchal cartilage, and flap transfer through a prepared skin canal to preserve the natural alar groove and reduce pedicle compression. Postoperative complications and aesthetic outcomes were evaluated.

All flaps survived without total loss. Partial distal necrosis occurred in two patients and was successfully managed with skin grafting and secondary revision. Postoperative venous congestion developed in two patients and was treated with leech therapy. Trapdoor deformity occurred in four patients and improved with conservative management. Revision procedures were required in six patients, including flap thinning in four cases and secondary revision after partial necrosis in two cases. Defects measuring up to 6 cm were successfully reconstructed with satisfactory contour, color match, and preservation of nasal airway patency at a follow-up of 9-12 months.

The two-stage delayed and prelaminated nasolabial flap is a reliable and versatile option for selected nasal defects, including full-thickness and complex partial-thickness reconstructions, providing durable structural support with minimal donor-site morbidity.