title: The subcutaneous melolabial island flap for nasal alar reconstruction: a clinical review with nuances in technique.
abstract: OBJECTIVE
  To describe our experience with surgical reconstruction of whole subunit nasal alar skin losses following Mohs ablative surgery, using a subcutaneous melolabial island flap with emphasis on a simplified technique to minimize facial scarring and optimize facial contour.
  
  
  METHODS
  Retrospective review of case series.
  
  
  METHODS
  A single surgeon's results in 48 consecutive patients spanning 7 years were analyzed by comprehensive chart review. Details of wound site and flap-specific complications were noted. Favorable nuances in surgical technique differing from standard approaches are graphically described.
  
  
  RESULTS
  Loss of melolabial sulcal depth was the most commonly seen donor-site complication (8%). No cases of flap compromise were seen. An unexpectedly high frequency of subjective nasal obstruction was seen (37%) after the second stage, more common when cartilage grafts were underutilized, and with through-and-through defects at inception. External contour was uniformly good to excellent.
  
  
  CONCLUSIONS
  The described variation in subcutaneous melolabial island flap transfer provides reliable soft tissue replacement for whole subunit alar skin losses with favorable donor-site scarring and resultant contour. Attention to proper utilization of supportive cartilage grafts and ancillary debulking procedures is often necessary to optimize functional outcomes.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, William Beaumont Hospital, Troy, Michigan, USA. richardlarden@aol.com
authors.forename: Richard L
authors.initials: RL
authors.lastname: Arden
authors.forename: George S
authors.initials: GS
authors.lastname: Miguel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002356:Cartilage / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D015580:Mohs Surgery; D015508:Nasal Obstruction / Q000209:etiology; D009669:Nose Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting / Q000379:methods