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In Reference to Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction

We read with interest the article “Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction” by Chakrabarti et al. An islanded, one-stage arterialized nasolabial flap was described in 1981 by Rose for the repair of a floor of mouth defect. The elliptical skin flap over the nasolabial crease was elevated between the skin and the level of the buccinator, completely islanded, and isolated on skeletonized facial artery and vein, exactly in the same manner as described by Chakrabarti et al. in their article. The same flap, the islanded facial artery flap, with the same description of elevation, was again described by Piggot et al. in 1987, in which the flap was introduced deep to the mandible for the repair of a floor of the mouth defect. Even a full-thickness, through-and-through, islanded arterialized flap, based on facial vessels incorporating the buccal mucosa, was described by Sasaki et al. in 1984 for reconstruction of esophageal strictures and limited defects of the upper aerodigestive tract. The authors cite an article by Nueangkhota et al., where a contralateral islanded nasolabial flap was used for tongue reconstruction as an example of use of this flap. However, an oversight in the review of the literature might have caused the authors to not include the references of the above-mentioned seminal articles in their article. The tenor of the article is suggestive of the authors describing exclusive use of this flap for limited postoncologic resection defects of head and neck cancers by them. This option of using skin from the face as an islanded flap could never become a popular reconstructive option, despite existing in the armamentarium for over 4 decades, due to the inherent reluctance to use facial skin as a donor for nonfacial areas, high risk of injury to marginal mandibular nerve, loss of lower buccal facial nerve branches, and a possible compromise on obtaining nodal clearance to preserve facial vessels. It is submitted that the rightful recognition belongs to the pioneering authors who described the islanded skin flap based on facial vessels in the 1980s. It is neither a novel flap, nor it has been used exclusively by the authors for head and neck reconstruction following oncologic resections.