Subnasale Flap for Correction of Collumelar Deformity
To date, existing technique for the reconstruction of collumelar defects are difficult to perform and plagued by technical limitations, and no current standard exists for the sole purpose of aesthetic improvement. Several methods have been described, including composite graft, nasolabial flap, forehead flap, depressor anguli oris island musculocutaneous flap, transverse forked flap, and nasal floor flap. However, the postoperative morbidity and scarring associated with these techniques render such procedures inappropriate for aesthetic improvement in cases of simple collumelar reconstruction or transposition.
There are several advantages of the so-called subnasale flap. Because of its proximity to the columella, this flap can be elevated in continuity within the same visual field as the defect itself. The short length of the flap virtually guarantees its survival, and scarring from the donor site is not a problem because it is elevated from the nasal cavity. Moreover, this flap can be transposed into the contra lateral side of the columella for the correction of severe collumela deviation. The following is an introduction and analysis of the subnasale flap to briefly review the existing methods for collumelar reconstruction.
PATIENTS and METHODS
The incision starts in the subnasale region, extending into the nasal cavity. The width at the flap base should overlie the footpate region. For reconstruction of the columella, the flap is undermined into the nasal cavity until an adequate length is reached. The flap thus created is then rotated into the midline to cover the defect. The entire length of the columella should be taken for better insertion good symmetry postoperatively. For closure of the donor site, the adjacent tissue is undermined and transposed into the defect. Immediately after surgery, the wound looks like a close T incision. Excessive pressure on the flap is best avoided for flap survivals (Figs. 1 through 3).
For correction of a deviated columella, the flap starts from the central portion of what would be the reconstructed columella. Adequate thickness should be harvested to achieve the desired height. The width of the flap is then carried on the other side and transposed into the smaller nostril (Figs. 4 and 5). The collumela skin is also elevated and then placed into the larger nostril, with the distal end inserting into.