A cosmetically-acceptable resurfacing the nose after tumor extirpation or traumatic tissue loss can be a challenging undertaking. Dieffenbach first popularized the Nasolabial flap in 1846, and since then several methods of repair have been described. Drawbacks to these flap designs include flattening of the nasolabial fold, alteration of the alar groove anatomy and an inherent requirement for staged operations. The use of rotation and advancement flaps for resurfacing small surgical defects of the nasal tip and ala deserves reappraisal. The rich and arborizing blood supply of the nose and cheeks allows for the engineering of numerous flaps based both on the subcutaneous and dermal plexuses as well as the myocutaneous perforating arteries of the region. We describe a new local flap grouping which combines a local Banner flap and the nasolabial flap described by Elliott and Dieffenbach. The first action is a 90-degree rotation of a donor flap to fill a recipient defect, followed by a V-Y advancement of a second juxtaposed flap to fill the defect created by the rotation of the first flap. This is a retrospective review of 20 patients between 2000 and 2004. A single surgeon's reconstruction of nasal tip and alar defects is presented. The flap combination utilized serves to resurface defects on the nasal tip and ala without flattening the nasolabial fold or erasing the alar groove. There was no flap loss, 2/20 (10%) patients experienced minor wound infection requiring antibiotic therapy, and 4/20 (20%) flaps required a subsequent defatting procedure to maximize cosmesis. Preoperative, intraoperative and postoperative photos are presented.
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