Reconstruction after BCC surgery – Pedicled nasolabial flap
How is a pedicled nasolabial flap performed?
A nasolabial flap is taken from the nasolabial area, which is the ‘smile line’ on the cheek, next to the nose and mouth. Broadly speaking a cut is made along the crease line, from near to the nose down to near the mouth. The cut then curves round to come back up on the cheek, about 15mm away from the first cut. The skin is then lifted with the underlying fat, but kept attached at the upper cheek area. This is called the flap, and it is now twisted to reach the wound on the nose.
The flap is stitched in place on the wound, and the cheek wound is closed.
The nasolabial flap is kept attached to the cheek, as this is how the blood flows in and out of the flap. Over the next 3-4 weeks the flap ‘learns to live’ from the nose, and new blood vessels from the nose grow into the flap skin. At this point, the flap can be divided from the cheek as the skin can now survive on the nose.
Sometimes, a cartilage graft is also used under the nasolabial flap, to help give the nose more strength and shape.
What is a cartilage graft?
A cartilage graft is a piece of cartilage, often taken from the ear, that is stitched into the nose to give it more strength and better shape. This can be very important if the nose strength has been lost after basal cell carcinoma surgery to an extent that the nostril is closing in and breathing is difficult. The cartilage graft is usually take from the ear through a cut on the front or back, and the shape of the ear only changes very slightly. Sometimes, for larger grafts, rib cartilage can also be used.
What happens while the pedicled nasolabial flap is attached?
The nose, flap and cheek will usually have dressings on them, and over the first few days the wound can ooze a little so the dressings may need changing every few days. This usually stops after 4 or 5 days. Any non-dissolving stitches will usually be taken out after about 5 or 6 days, then it’s a case of just waiting until the 3 or 4 week stage, when the flap is divided.
How is a pedicled nasolabial flap divided?
At the cheek, the flap skin is cut free and the wound is stitched closed. At the nose, the flap is thinned and sculpted to try and match the contours of the nose, and stitched in place. Any non-dissolving stitches are removed at 5-6 days.
During the first few weeks the flap can swell and look too bulky. Usually, after a few months, this goes down and the flap settles in place.
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This information is for general knowledge only and does not replace information provided by healthcare professionals. If you have any concerns about any skin growth, or the treatment options, you should consult a medical professional urgently