title: Superiorly based nasalis myocutaneous island pedicle flap with bilevel undermining for nasal tip and supratip reconstruction.
abstract: BACKGROUND
  Superiorly based flaps with bilevel undermining for the reconstruction of nasal tip and supratip defects have not been utilized to this point for reconstruction of this cosmetic subunit.
  
  
  OBJECTIVE
  The purpose of this presentation is to describe a new flap for the reconstruction of nasal tip and supratip defects and to introduce a new method of undermining-bilevel undermining-in the raising of these flaps.
  
  
  METHODS
  In this presentation we demonstrate (diagrammatically and with fresh cadaver dissection) the methods of preparing, raising, and preforming this new flap. We further introduce and describe the concept of bilevel undermining.
  
  
  RESULTS
  We describe the first author's 4-year experience in the development of this flap. We show clinical representative cases with pre- and postoperative results.
  
  
  CONCLUSIONS
  Superiorly based myocutaneous island pedicle flaps with bilevel undermining, a new method of nasal tip and supratip reconstruction, yields excellent functional and cosmetic results. Bilevel undermining is a new and valuable method of achieving greater tissue mobility in muscle-based flaps.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Papadopoulos
authors.forename: F A
authors.initials: FA
authors.lastname: Trinei
mesh_terms: D000792:Angiography; D006801:Humans; D008866:Microsurgery / Q000379:methods; D015580:Mohs Surgery; D009669:Nose Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome