Reconstruction of a Surgical Defect Involving the Nasal Ala and Alar Crease

This chapter discusses a case of an 80-year-old man, who was referred for Mohs micrographic surgery of a squamous cell carcinoma of the left nasal ala. The lesion was cleared in one stage by Mohs surgery. The patient presented a challenging defect of the left nasal ala and alar crease. A bilobed transposition flap may avoid nasal valve obstruction through two mechanisms: closure of its second lobe in an area distant to the ala and alar crease, and a relative shorter angle of transposition. The choice of a medial-based pedicle prevents dysfunction of the nasal valve through avoidance of surgically crossing the alar crease. To avoid blunting of the alar crease and to help keep patent the nasal vestibule, a single buried absorbable tacking suture holds the flap securely to the wound bed. After healing, the patient reported no nasal stuffiness or decrease in airflow.