This article highlights the history, applications, and versatility of the nasolabial flap. The nasolabial flap. USA.gov. This maneuver is best accomplished with facelift or Dean’s scissors. 2005 Jul;18(5):330-9. doi: 10.1002/ca.20108. The nasolabial crease runs linearly from 1 cm superior and just lateral to the ala of the nose to 1 cm lateral to the oral commissure. In excessively long flaps, the perfusion pressure to the distal aspect may not be adequate for viability. 2017 Jan-Mar;10(1):22-27. doi: 10.4103/0974-2077.204576. Delayed bipedicled nasolabial flap in facial reconstruction. When the nasolabial flap has been used before, or its blood supply compromised, the delay procedure can reestablish its applicability. This point is particularly important when harvesting a thin flap that does not include the named axial vessel. Prakash S, Panda R, Kumar V, Saha SS, Choudhary L, Pandey A, Reddy JS. This report seeks to clarify the situation. 2016 Nov 23;12:79-87. doi: 10.1016/j.amsu.2016.11.008. This report seeks to clarify the situation. Preoperative history and physical examination is critical in determining the flap variant to be used. The nasolabial flap may be used as a random or axial pattern flap and can be pedicled superiorly or inferiorly. CONCLUSION: The nasolabial flap is a versatile and effective option for the closure of nasal defects of the cheek and nasal sidewall. Alternatively, a similar result can be obtained, particularly for intraoral reconstruction, by harvesting a standard thin pedicled nasolabial flap and carefully de-epithelializing the base. A pinch test can be used to assess flap width to be harvested starting 2 to 3 mm lateral to the nasolabial crease extending laterally into the cheek. Arch Plast Surg. Nasolabial Perforator Flap for One-stage Reconstruction of Nasal Defects. However, the first recorded description dates back to an Indian surgeon, Sushruta, in 600 bce . The vascular supply of this region is derived from perforating branches of the facial artery inferiorly, and angular artery superiorly. The margins of the buccal mucosa and flap are approximated and closed primarily. The reader is presented with 5 patient examples using the nasolabial flap for maxillofacial reconstruction. Adequate length should be incorporated to allow for a tension-free inset. Maintaining a thin layer of subcutaneous fat distally ensures random pattern subdermal plexus capture, while allowing appropriate thickness match for reconstruction. Skin flaps should be sharply raised in a supra-SMAS plane, taking care to raise more length laterally than medially. Anatomic dissections were performed on 12 cadaveric specimens and microangiography on six others. This segment is undermined, and donor site primarily closed. The nasolabial flap has been commonly described and used for facial soft tissue reconstruction since the 19th century. Variations of flap design, harvest, and inset are described. This offset in thickness can result in tenting of the flap and internal compression when insetting, leading to venous obstruction. However, the first recorded description dates back to an Indian surgeon, Sushruta, in 600 bce. Hynes B(1), Boyd JB. This report seeks to clarify the situation. NIH Gauze or suture is used to simulate the flap length and rotated around the proposed base to determine its reach into the recipient site. Bayer J, Schwarzmannová K, Dušková M, Novotná K, Kníže J, Sukop A. Acta Chir Plast. | It is important to minimize undermining near the oral commissure and medial canthus because this will laterally distort these structures if closed under tension. Author information: (1)Department of Surgery, Toronto General Hospital, Ontario, Canada. The place of nasolabial flap in orofacial reconstruction: A review. Pomahac B, Lengele B, Ridgway EB, Matros E, Andrews BT, Cooper JS, Kutz R, Pribaz JJ. By completely islanding the flap, a skin paddle can be tunneled subcutaneously to reconstruct nasal or cheek cutaneous defects not in continuity with the planned donor site. As the dissection proceeds proximally, the flap harvest may be completed in a deeper plane. Nasolabial flap is brought into the buccal space through this tunnel (Figure 3b). Use of Bilateral Nasolabial Flaps with Coronoidectomy as a Novel Approach to a Case of Oral Cancer with Severe Trismus. NLM The tumor is excised and the defect reconstructed in two steps using a 2012 Aug;70(8):1997-2004. doi: 10.1016/j.joms.2011.08.043. The supraclavicular artery flap: a versatile flap for neck and orofacial reconstruction. 2010 Feb;125(2):517-22. doi: 10.1097/PRS.0b013e3181c82e6f. Please enable it to take advantage of the complete set of features! Plast Reconstr Surg. Anatomic dissections were performed on 12 cadaveric specimens and microangiography on six others. A distal to proximal harvest with monopolar cautery or a scalpel can be completed expeditiously within the subcutaneous fat. Including the angular or facial vessels; however, necessitates dissection in a supraperiosteal plane, which is generally not required. Considerable confusion exists regarding the nature of the blood supply of the inferiorly based nasolabial flap. J Cutan Aesthet Surg. Anatomic dissections were performed on 12 cadaveric specimens and microangiography on six others. The length of the flap should be within the boundaries of the nasolabial fold for acceptable donor site closure. It is important to avoid the temptation to back-cut the base of the flap to increase rotational arc or avoid a standing cutaneous cone as this will compromise the vascularity of the distal third. The nasolabial region anatomy is surprisingly more complex than it seems. Indian J Surg Oncol. Although the vasculature of the flap is technically random, the small vessels of the subdermal plexus are generally oriented along its long axis giving it a "degree of axiality." 2016 Dec;20(4):411-415. doi: 10.1007/s10006-016-0582-1. doi: 10.1001/archotol.1988.01860240039019. Get the latest research from NIH: https://www.nih.gov/coronavirus. Because the distal one-third to one-half of the flap will most likely be used for the planned reconstruction, maintaining the desired thickness is critical. Epub 2019 Dec 23. 2020 Jun;11(2):212-215. doi: 10.1007/s13193-019-00966-x. For most applications on the face, random pattern harvest is favorable and allows a thinner, more pliable flap to match the recipient site soft tissue. A suture or unfolded surgical sponge may be used to design the overall dimensions of the flap. This ensures adequate capture of the subdermal vascular plexus and associated perforators, but any wider may limit the arc of rotation. Epub 2011 Dec 16. When based axially, it can be carried on the facial artery as an inferiorly based flap, or angular artery as a superiorly based flap. Because the donor site is central on the face, a meticulous tension-free closure is required to prevent unfavorable scarring or facial distortion. Prior facial incisions, scars, and local flap harvest sites may preclude its use if the subdermal vascular plexus has been disturbed. 2018 May;45(3):253-258. doi: 10.5999/aps.2017.00878. The ease of harvest, robust blood supply, and versatility of the flap lends itself to multiple applications. Laryngoscope. The optimal width of the base of the flap should be approximately 2 cm. Vascular considerations in composite midfacial allotransplantation. We confirmed that the facial artery passes deep to the facial mimetic muscles and is not normally included within the flap. The nasolabial musculocutaneous flap: clinical and anatomical correlations.
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