Nasal Sidewall Propeller Flap for 1-stage Reconstruction of Lateral Nasal Ala Defects

Cutaneous carcinomas of the lateral nasal ala, sometimes extending to the upper lip triangle, frequently require superficial or full-thickness resections. Despite their small size, these defects present a significant reconstructive challenge due to the 3-dimensional anatomy and high functional and aesthetic demands of the nasal region. We describe a 1-stage reconstructive technique using a nasal sidewall propeller flap (NSPF), a freestyle perforator flap harvested from the homolateral nasal sidewall, based on perforators from the facial or internal nasal artery. When needed, the NSPF is combined with a transverse jugal advancement flap to restore the continuity of the upper lip aesthetic subunit. Seventeen patients with lateral nasal ala defects were treated using this method: 12 NSPF and 5 melolabial propeller flaps. No flap necrosis occurred. A second-stage aesthetic refinement was necessary in 3 NSPF cases and all 5 melolabial propeller flap cases. The NSPF offers a reliable, easy-to-harvest, single-stage alternative to multistage flaps and free cartilage grafts. The technique provides excellent color and texture match and minimizes donor site morbidity. Its versatility and reproducibility make it an effective option for lateral nasal ala reconstruction.