Elective Reconstruction of Perioral and Alar Defects Using a Subcutaneous Island Pedicle Flap: A Case Report

Subcutaneous island pedicle flaps are versatile reconstructive options in dermatologic surgery, particularly in cosmetically and functionally demanding facial regions. Their robust vascularity, preservation of adjacent aesthetic units, and ability to recruit tissue with similar color, texture, and thickness make them especially useful for reconstruction of defects involving the perioral region and nasal ala. We report the case of an elderly woman with synchronous facial basal cell carcinomas involving the right upper cutaneous lip and the right alar groove. Following complete surgical excision, reconstruction was performed using a unilateral subcutaneous island pedicle flap (island flap) designed along the nasolabial fold. The flap provided adequate mobility to reconstruct both defects while maintaining the natural contour of the upper lip, alar-facial sulcus, and nasolabial fold. Postoperative evolution was favorable, with excellent vascular viability, preservation of oral competence, and satisfactory cosmetic integration at one month. This case highlights the utility of the island pedicle flap as a single-stage reconstructive option for adjacent perioral and nasal defects, emphasizing principles of aesthetic subunit reconstruction and tissue conservation.