Sunday, August 20, 2017

NLF workhorse: Staged repair of a full thickness traumatic nasal defect

This child presented to our mission clinic years ago, with  a complicated full thickness defect of her nose following trauma and infection

The first stage NLF was used to cover the  turned in flap from the nose and surrounding cheek

The patient did well post operatively and was scheduled for follow up adjustments at a later date.

The naso labial flap is a sort of workhorse for the facial region because it is easy to raise at a subcutaneous plane and is generally viable if done carefully.

Type: arterialised local flap in the head and neck region

Important: " the robust viability of the flap on the basis of a small subcutaneous and subdermal
blood supply " (Barron, J. N., and Emmett, A. J. J. Subcutaneous pedicle
flaps. Br. J. Plast. Surg. 18: 51, 1965)

Axial blood supply:  provided by the  facial artery (inferiorly based) or by
the superficial temporal artery through its transverse
facial branch and the infraorbital artery (superiorly
based).

maximum dimensions of the flap : 7 cm by 1.5 cm.

Important Aesthetic Considerations:

• The preservation of the nasofacial aesthetic
line when possible
• Its optimal use in nonsmokers
• Its best results when used for defects involving
part or all of the alar subunit or the lateral
side wall (2 cm in width)
• The use of a nonanatomic alar contour
graft for lesions within 5 mm of the alar rim
• The precise fit of the donor flap into the
recipient site, as well as adequate debulking
and the obliteration of any dead space with
transfixation sutures (through and through) to
prevent pin-cushioning
• The maintenance of a 2-mm isthmus lateral
to the ala on the cheek for optimal
cosmesis
The plastic and reconstructive surgeon is often
presented with a patient who has multiple
defects secondary to skin cancer. In this article,
we presented a unique application of a nasolabial
flap used for a simultaneous cheek and
nasal defects, with preservation of the nasofacial
aesthetic line. ( ref: page 1729 ;R Rohrich,Dept of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, SUPERIORLY BASED NASOLABIAL FLAP) PRS Vol. 108, No. 6  Nov 2001/

Uses:
reconstruction of the lower eyelid and small defects of
the nose, lips and oral cavity.
 In cancer treatment -for reconstruction of the floor of the
mouth,1–3 palate4 and ala of the nose.5 The recent innovation
of folding the flap has further expanded its role,
as it is now able to provide lining and cover for a fullthickness
commissural defect.




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