Nasolabial Fold Retrograde Island Flap With Local Heparin Injection For Nasal Defect Repair Following Basal Cell...

Basal cell carcinoma (BCC) frequently involves the external nose, necessitating radical surgical excision that often results in complex soft-tissue defects. While the nasolabial fold retrograde island flap offers an aesthetically superior reconstructive option due to its excellent color and texture match, its reliance on a reverse-flow subcutaneous pedicle makes it highly susceptible to venous congestion, which can compromise flap survival. The goal of this protocol is to demonstrate a modified surgical technique that incorporates immediate postoperative local microinjection of heparin sodium to mitigate this specific vascular risk. The procedure involves the radical excision of the nasal tumor, followed by the harvesting and rotation of a subcutaneous pedicle island flap from the ipsilateral nasolabial fold. To address the challenge of venous stasis, heparin sodium is micro-injected into the full thickness of the flap in a multi-point grid pattern immediately after suturing. This intervention utilizes both pharmacological anticoagulation to prevent microthrombosis and mechanical decompression via needle puncture to facilitate venous drainage. In a clinical application involving 24 patients, this protocol achieved a 100% flap survival rate. Early signs of severe venous congestion observed in three cases (12.5%) were successfully reversed within one week through continuous local heparin therapy. Advanced clinical data analysis indicated that flap size was not an independent predictor of venous congestion, demonstrating the robustness of this technique even for larger defects. Furthermore, systemic safety assessments confirmed no clinically significant coagulation abnormalities or adverse events. This method offers a safe, reproducible, and effective strategy for ensuring high-quality flap survival and favorable aesthetic outcomes in nasal reconstruction, avoiding the risks associated with systemic anticoagulation.