Reconstructing the nose, especially the alar-facial groove, is difficult because of its 3-dimensional structural characteristics. We report the case of a 33-year-old man with a history of crush injury to the nose 15 years previously. We performed reconstruction because of scar contracture formation in the left alar-facial groove (Fig. 1).
This study was reviewed and approved by the Ethics Review Board of the Inje University Health Center.
A V-Y advancement flap was designed by setting the nasolabial fold as the superior margin and the elevated alar-facial groove as the medial margin. A cutaneous perforator flap was then elevated [1]. The scar tissue in the alar-facial groove, including the skin and subcutaneous layer, was minimally excised, by 1.0×0.2 cm (Fig. 2).
The septum was peeled back to expose the anterior nasal spine, and the bottom surface of the alar side was fixed to a firm area near the anterior nasal spine. This can be done via open rhinoplasty or a minimal incision in the mucosa inside the nostril (Fig. 3).
The alar-side surface of the area from which the scar tissue was excised and the medial area of the nasolabial V-Y flap were sutured together. In this manner, a stronger and more prominent secondary alar-facial groove was constructed (Fig. 4).
The definitive treatment for patients needing alar-facial groove reconstruction has not been established. The skirt flap is not optimal for a prominent alar-facial groove [2], nor is the feather-edge rolled-in flap optimal for resolving the tension around the groove [3]. We used a nasolabial flap and ‘tissue-adding’ to reconstruct the alar-facial groove. This technique reduces tension and yields more prominent results by providing a force in the medial direction.
