Kevin T. Kavanagh, MD - ENT USA

 Flaps wider than 1.5 c
which is difficult to clo
of a large defect can re
nasal ala (superiorly ba
of the nasal ala (inferio

 Flaps longer than 2.5 t
risk of tip necrosis.

 Thus, the maximum le
3.75 cm.

cm can create a defect
ose. In addition, closure
esult in widening of the
ased flaps) or notching
orly based flaps).

times the width are at

ength should be around

 Superiorly Based

◦ Can easily reach most na
◦ Because of poor lymphat

swell. Look good right a
become hypertrophic at
resolution of the swellin
◦ Glasses rest on the flap’
swelling and chances of
◦ The higher the base of t
has to rotate and the les
◦ Need to plan for a secon

asal defects.

tic flow (uphill) they tend to
after the operation but
one month, with some
ng by six months postop.

’s base which increases
necrosis.

the pedicle the less the flap
ss of a dog ear will form.

nd stage to thin the flap.

Basal cell carcinoma of the
left nasal ala.







Three Mon

nth Postop Result – Note Flap Swelling

Five Month

h Postop Result – Note Flap Swelling





Flap Length to

o Width Ratio Was 2.5 to 2.75 To 1

Immediate Postop Result

Five Days – Tip Necrosis

Three Wee

ek Postop, Note the Flap’s Swelling



Nine Month Postop Result

 Inferiorly Based

◦ Can be used to reconstru
alar defects.

◦ Rotation is very acute an
tends to blend into the n

uct some inferior or nasal

nd a dog ear forms, but this
nasal alar defect.





Note the crease in the
midportion of the flap
and the purplish hue of
the distal ½ of the flap



At one
viable b

week postop, the distal ½ of flap is
but is dusky and NOT healthy.





Used to reconstruct defects
between 1/3 to 2/3 of the lip.

Axial flap – based medially. A
portion of the opposite lip equal to
½ the defect is rotated into the
defect.

If you base the flap laterally – more
likely to cut artery and may not
have enough room to rotate flap
into position.











Lip is divided and the vermillion
portion of the lips are rotated into
position.



The three month postoperative result is
reinnervated and the patient is even ab

s shown above. Note that the flap has
ble to whistle.

 Nasal reconstruction wi
believed to originated in In

 The flap is a paramedi
axial flap based upon
supratrochlear artery.

 If the flap’s pedicle is
wider than 2.5 cm,
closure may be difficu

ith the forehead flap was
ndia in 700 BCE
ian
the

ult.





Note that the flap’s
pedicle is narrower
than the tip. This is
to aid in closure of
the forehead. The
tip will be used for
the nasal
reconstruction.

If necessary, the
artery can be found
using a doppler.