Repair of the left nasal sidewall, nasofacial sulcus, and medial cheek

A new alternative for reconstruction of the inferior medial canthal and nasal sidewall defects

BACKGROUND

Reconstruction of the inferior medial canthal and nasal sidewall defects presents some particular problems resulting from the unique anatomy of this region such as the multiple contours and sigmoidal relaxed skin tension lines, differences in skin color and texture, and the anatomic limitations presented by the adjacent structures including lower eyelids, eyebrows, and lacrimal drainage system.

PURPOSE

In this study, the authors represent a new local flap as a new alternative for reconstruction of the defects of the inferior medial canthal region and nasal sidewalls.

METHODS

In this technique, defect closure is achieved by using 2 cutaneous flaps designed in an unequal z-plasty manner. The first flap is used to cover the defect, whereas the second flap is used for closure of the first flap's donor site. From October 2006 to May 2010, a total of 16 patients 38 to 80 years old underwent medial canthal and nasal sidewall reconstruction by using this procedure. The defect size ranged from 2.0 to 3.2 cm in width.

RESULTS

A tension-free defect closure was achieved in all patients. Except 1 patient who had slight pseudoepicanthus, there was no patient with distortion of the surrounding anatomic structures. During a mean follow-up period of 30 months (5 months to 3½ years), all patients were satisfied with the cosmetic and functional results. Except 1 patient who underwent reoperation for tumor recurrence, no patient required further surgery.

CONCLUSIONS

The reading man procedure was found to be a successful technique for the closure of inferior medial canthal and nasal sidewall defects. It allows tension-free closure of considerably larger defects without any additional healthy tissue excision and and/or dog ear formation. Moreover, using z-plasty principle, it avoids distortions of the surrounding mobile anatomic structures.

Superiorly based bilobed flap for inferior medial canthal and nasojugal fold defect reconstruction

PURPOSE

To evaluate the use of a superiorly based bilobed flap for reconstruction of nasojugal fold region defects.

METHODS

Retrospective review of all patients undergoing medial canthal, nasal sidewall, and nasojugal fold region reconstruction using a superiorly based bilobed flap from October 2000 through March 2008. Charts were reviewed for patient age and gender, indication, defect size and location, flap(s) used, and follow-up time. Outcome measures included ability to completely close the defect with minimal tension, cosmetic appearance, complications, and need for further surgery.

RESULTS

Eighteen cases of medial canthal and nasojugal fold area reconstruction were performed using a superiorly based bilobed flap in 17 patients. There were 8 male and 9 female patients with an average age of 68.2 years (range, 11-88 years) and mean follow-up time of 17.8 months (range, 1-60 months). Mean defect size measured 2.0 x 1.4 cm (range, 0.7-4 cm). One patient underwent simultaneous glabellar flap repair, 2 patients underwent simultaneous lateral lower eyelid rotational flap repair, and 1 patient underwent simultaneous upper eyelid V-Y advancement flap. All defects closed completely with no wound tension. No cases of hemorrhage, infection, dehiscence, or necrosis developed during the follow-up period. Cosmetic satisfaction occurred in 16 of 17 patients. Complications included mild medial ectropion (2 patients) and canalicular stenosis (1 patient). None of these patients elected reoperation. Trapdoor deformity did not occur in any case. Two patients underwent reoperation for local tumor recurrence.

CONCLUSIONS

A superiorly based bilobed flap adequately reconstructs inferior medial canthal, nasal sidewall, and nasojugal fold defects.