The versatile menu of the nasolabial flap in nasal reconstruction: A defect-based algorithm

The nasolabial flap is a reliable option in nasal subunit reconstruction, but its versatility often remains underappreciated. This study aims to highlight a plethora of different application options of the nasolabial flap for nasal defects, while proposing a reconstructive, defect-based algorithm.

In a retrospective case series, patients with nasal subunit defects reconstructed using a nasolabial flap between 2014 - 2024 by a single plastic and reconstructive surgeon were included. Data analysis included patient demographics, defect characteristics, nasolabial flap characteristics, perioperative data, and postoperative outcome. Different nasolabial flap applications were categorized into eight variants according to defect analysis by nasal subunit, defect depth, and reconstructive complexity. Patient and surgeon satisfaction was rated applying a modified Whitaker scale.

Twenty-three patients (n = 23) were included and classified into the subgroups according to the nasolabial flap applied. In 91.3%, nasal defects were caused by prior skin cancer resection or complications thereof. Defect size ranged from partial (4.3%) and single-subunit defects (78.3%) to multi-subunit defects (17.4%) with varying defect depth between partial- and full-thickness defect. Based on thorough defect analyses, a defect-based treatment algorithm was derived. Variants of the nasolabial flap included transposition and island flap designs, one- vs. two-staged flaps, the nasolabial flap as an enfolding flap or in combination with a turn-over flap with or without concha cartilage grafting. No major complications or flap losses occurred. Postoperative outcome rating showed a high patient satisfaction rate with only one patient demanding a corrective surgery.

The nasolabial flap is versatile and simple, making it highly suitable for facial reconstruction in everyday clinic. Use of the proposed defect-based treatment algorithm enables precise decision making depending on the defect to reconstruct.