Surgical defects of the midline nasal region (dorsum and/or nasal tip) frequently present a reconstructive challenge in dermatologic surgery. For large defects affecting this region, the preferred flap is usually the paramedian forehead flap (PMFF), a minimum two-stage procedure with a 2–3 week interval between the surgeries, significantly reducing the patient's quality of life.1-4 The nasolabial transposition flap (NLTF), commonly used to repair defects affecting the nasal ala and sidewall, may represent a potential alternative for reconstructing extensive midline nasal defects in a single stage in selected patients, as described by Beustes-Stefanelli et al.5 This study aims to provide further insight into this variant NLTF and its main clinical, aesthetic and functional results. We performed a retrospective descriptive study of a multicentre series of patients who underwent surgical excision of nasal skin cancer and in whom an NLTF was used to repair an extensive midline nasal defect (at least involving dorsum and/or tip). Extensive defects were defined as those exceeding 2 cm in diameter. One to two months after surgery, the dermatologist who performed the procedure evaluated the aesthetic and functional results, rating them on a scale from 0 to 10 without using standardized criteria. The series comprised 10 patients: 6 women and 4 men, aged between 46 and 92 years (mean, 75 years). In terms of factors that can influence flap survival, two patients were smokers (20%), two had diabetes (20%), and one was taking anticoagulants (10%). Regarding histological features, all patients presented basal cell carcinoma except for two cases in whom squamous cell carcinoma was excised. Mohs surgery was performed in all cases except one, where wide local excision with clear margins was performed. Seven dermatologists performed the surgeries, with one performing the procedure on four of the 10 patients. The mean defect diameter was 2.98 cm (range 2.2–3.5 cm). All defects affected more than one aesthetic subunit. The NLTF was considered for defects in the nasal tip that could potentially extend to the lower dorsum (observed in seven of our patients) or the ala (observed in the remaining three patients). In seven cases, the flap was designed unilaterally and in three cases, bilaterally. The NLTF allowed complete closure of the skin defect in all cases (see Figure 1 for the step-by-step process). In two patients, with deep tissue defects affecting the cartilage, the NLTF was previously combined with a structural cartilage graft from the patient's antihelix. There were no postoperative complications except in one of the bilaterally designed NLTF cases, where partial necrosis of the flap occurred, despite the absence of other risk factors that could have influenced flap survival. Otherwise, excessive flap thickness developed in only one patient, requiring surgical correction. The mean follow-up period was 6.1 months (range 1–20 months). The average functional score was 9.6, and the average aesthetic score was 7.9. Based on our results, NLTF could be an alternative option for reconstructing extensive defects of the nasal dorsum and tip in selected patients, achieving satisfactory functional and aesthetic outcomes. Compared to PMFF, the main advantage of NLTF is that it is a single-stage procedure, which is especially beneficial for elderly patients.5 Further advantages include avoiding visible scarring on the forehead and reducing the risk of transposition of forehead hair, which can occur when PMFF is performed.4 When the defect also involves the alar subunit, the potential risks of nasal valve compromise and alar distortion must be considered. This risk can be mitigated by using structural cartilage grafts when the defect is deep. The unilateral NLTF design may be preferable to the bilateral design, as it enables better subunit reconstruction and potentially reduces the risk of partial flap necrosis because of its wider pedicle. However, this conclusion is based on a limited number of cases, and further studies are needed to confirm these findings. The limitations of our study include its small sample size and retrospective, descriptive design. Nevertheless, to our knowledge, this is the study with the largest number of cases using this technique. Other limitations include a potential observer/rater bias, the lack of standardized criteria for evaluating surgical outcomes and the relatively short follow-up period for assessing scar maturation and contour changes in nasal reconstruction. Further research is needed to compare the two techniques, and it would be interesting to consider patients' perceptions of changes in their quality of life and satisfaction with the outcomes. In conclusion, the NLTF may represent a single-stage alternative to the classical two-stage PMFF for reconstructing extensive midline nasal defects in selected patients. The authors have nothing to report. The authors declare no conflict of interest. Reviewed and approved by Hospital Clinic de Barcelona Clinical Research Ethics Committee (HCB/2020/0998). The patients in this manuscript have given written informed consent to the publication of their case details. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Lario‐González et al. (Fri,) studied this question.