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Tunneled transposition flap for reconstruction of defects of the nasal ala.

The extirpation of cutaneous malignancies from the nasal alae is a task that many Mohs surgeons undertake on almost a daily basis. Although the entire nose is a cosmetically significant structure, the nasal alae are particularly sensitive. Suboptimal reconstructions can leave a patient with a striking asymmetry and poor functional results. One of the most difficult types of alar defects to repair is the deep alar defect. Such defects do not readily lend themselves to skin grafts, and any planned flap reconstruction must seek to preserve the architecture of the alar crease, alar rim, and the nasolabial fold. With traditional methods for reconstruction of this type of defect, one or more of these considerations may be sacrificed. We shall describe a single-stage, tunneled transposition flap that is especially useful for this type of defect and produces excellent aesthetic results.