Can J Plast Surg Vol 10 No 2 March/April 2002 81 CASE REPORT A superiorly based, externally pedicled nasolabial flap for the repair of complex nasal tip defects Selig Krajden MD, Bert Van Brenk MD FRCSC, John L Semple MD FRCSC, Mitchell H Brown MD FRCSC Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario Correspondence: Dr Mitchell Brown, Sunnybrook and Women’s College Health Sciences Centre, Women’s College Campus, 76 Grenville Street, Suite 650, Toronto, Ontario M5S 1B2. Telephone 416-323-6336, fax 416-323-6325, e-mail mhbrown33@aol.com S Krajden, B Van Brenk, JL Semple, MH Brown. A superiorly based, externally pedicled nasolabial flap for the repair of complex nasal tip defects. Can J Plast Surg 2002;10(2):81-84. The reconstruction of nasal tip defects can often be quite chal- lenging. For small or superficial defects, primary closure, second- ary healing or skin grafting are common options. For larger, full thickness defects with exposed cartilage, local or distant flaps are usually required. An experience using a superiorly based, exter- nally pedicled nasolabial flap for full thickness nasal tip defects in six patients is described. The reconstruction is performed in three stages, allowing for aggressive thinning and debulking of the flap at the time of final insetting. The flap has good excursion with a wide arc of rotation, allowing it to be used in a variety of complex nasal tip defects. Patient satisfaction with the eventual outcome has been excellent. Key Words: Nasal reconstruction; Nasolabial flap Lambeau naso-labial à pédicule externe, supérieur pour les reconstructions complexes de la pointe du nez RÉSUMÉ : La chirurgie de reconstruction de la pointe du nez s’avère souvent fort délicate. Pour les pertes de substance superficielles ou de petite taille, la suture primitive, la cicatrisation secondaire ou les greffes de peau sont pratique courante. Par contre, pour les pertes étendues ou totales de substance, avec exposition du cartilage, il faut généralement recourir aux lambeaux prélevés à proximité ou à distance. Voici la descrip- tion d’une technique expérimentale pratiquée sur six patients et consis- tant en la pose d’un lambeau naso-labial à pédicule externe, supérieur pour perte totale de substance. La reconstruction se fait en trois temps, ce qui permet un amincissement et une réduction marqués du lambeau au moment de la mise en place finale. Le lambeau est facile à déplacer et présente un grand arc de rotation; il peut donc servir à un large éventail de reconstructions complexes de la pointe du nez. Les patients se sont montrés très satisfaits des résultats. T he reconstruction of a nasal tip defect can present a dif- ficult technical challenge for any surgeon. The ultimate goal of nasal tip reconstruction must incorporate closure of the original defect while restoring the cosmetic appearance of the nose, and minimizing distortion of surrounding struc- tures such as the alar rim and nasofacial groove. A variety of techniques have been described to achieve this goal; these include primary closure or secondary healing for smaller defects and local flaps, and full thickness skin grafts or com- posite grafts for larger nasal tip defects (1-4).