During the reconstruction of alar defects involving the upper lip, reconstructive
surgeons face the need for various thicknesses of tissues crucial to preserving the
facial sulcus which is important for a cosmetically acceptable result. Our aim was
to reconstruct the deep perialar and thinner lateral nasal alar defect in a single
step procedure with a suitable flap which is reliable, has appropriate blood supply
and provides an esthetically good result.Extended alar defect was reconstructed with
a combined flap in 10 cases. During the procedure, a subcutaneous pedicle was created
and the proximal part of the flap was rotated into the defect as a rotational flap.
The procedure and the follow-up have been photo-documented in all cases. Furthermore,
the perfusion of the flaps was monitored by means of laser Doppler flowmetry. Postoperative
complications were evaluated with a semi-quantitative score and the patients completed
a patient satisfaction questionnaire, too.An optimal esthetic result was obtained
in all cases after the operation. The lateral nasal alar part of the defect was reconstructed
with the thinner proximal part of the flap while the deeper perialar region involving
the upper lip was covered with the thicker distal part. The flaps have shown sufficient
blood flow after the operation. There was no significant pin cushioning or "trap-door"
effect in any case. Mild erythema and edema was found in few cases. The patients were
satisfied with the cosmetic result of the intervention.The flap is suitable for the
reconstruction of alar defects involving the perialar region. It has the advantage
of covering the deeper perialar and the thinner alar defects, whilst eliminating the
pin cushioning effect of the conventional subcutaneous island pedicle flaps.