This patient presented to me for nose reconstruction of this large defect of the left ala and cheek. The patient underwent Moh’s excision of an infiltrative basal cell carcinoma. Unfortunately, the tumor involved the near entirety of the left nasal ala.
Pictured here is the surgical defect along with the markings for the planned reconstruction. Since about 90% of the nasal ala was involved by tumor, the entire nasal subunit required reconstruction. In this case, a staged reconstruction with a pedicled naso-labial flap was performed. During the first stage, a template is created using the contralateral nasal ala (i.e. the intact nasal ala from the other side of the nose). This is then marked out over the projection of the skin flap on the affected side. A piece of the ear cartilage is harvested and then sewn into the defect in order to lend adequate structural support. Then the naso-labial flap is elevated, trimmed to the appropriate dimensions and then sewn into place within the defect. A bridge of tissue is left undisturbed in order to provide a healthy, adequate blood supply.
During the second stage of this reconstruction (about 3 weeks after the first operation), the bridge of skin and soft tissue is divided and is contoured to the correct dimensions. At this point, most reconstructions are complete. However, some patients will require a minor third stage operation around 6-12 months afterward for the purpose of thinning out the flap.