Subcutaneous Randomized Nasolabial Flap: Our Experience
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ORIGINAL ARTICLE
Subcutaneous Randomized Nasolabial Flap: Our Experience Navneet Agarwal1 • Payal Kumbhat1
•
Sukriti Agarwal2
Received: 5 August 2020 / Accepted: 24 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Nasolabial flaps are one of the oldest methods of reconstruction. This study aims to observe the viability of a random-pattern subcutaneous nasolabial flap. Inpatients of carcinoma of oral cavity and nose undergoing excision with primary reconstruction from January 2014 to December 2019 were observed and followed-up. Their data including site of primary and post-operative complication was recorded. A total of 38 patients underwent reconstruction using nasolabial flap. Most cases were of buccal mucosa carcinoma (68.4%). Facial vessels were ligated in all except 7 cases and, only 1 (2.6%) showed total, and 3 (7.9%) showed partial flap necrosis. A subcutaneous nasolabial flap is simple, viable and easy to harvest. It is a random-pattern flap therefore; facial vessel preservation may not be a compulsion. Flap raised subcutaneously is thinner and thus inset is easy and bulk associated discomfort is avoided. Keywords Nasolabial flap Subcutaneous Randomised
& Payal Kumbhat [email protected] Navneet Agarwal [email protected] Sukriti Agarwal [email protected] 1
Department of Otorhinolaryngology and Head and Neck Surgery, Dr. S.N. Medical College and M.D.M. Hospital, Jodhpur, Rajasthan 342003, India
2
Dr. S.N. Medical College and M.D.M. Hospital, Jodhpur, Rajasthan 342003, India
Introduction Historically, cheek flap and forehead flap were the first flaps described for head and neck reconstruction. The nasolabial flap was described for nasal reconstruction by Sushtruta in 600BC, and thus plastic surgery was born about 2000 years ago in India. Ever since, the nasolabial flaps have been a workhorse for face and oral cavity reconstructions. The relative ease of harbouring and ability to carry out this procedure under local anaesthesia along with the benefit of relatively minimal scar makes it one of the most widely used flaps. The nasolabial region is complex in its anatomy. The crease extending from lateral alar rim to the corner of mouth forms the nasolabial sulcus. Muscles lying beneath the skin and subcutaneous tissue of this region are platysma, risorius, zygomaticus major and minor, levator labii superioris and levator labii alaeque nasi. Deep to this and superficial to the buccinator runs the facial artery which is the major vessel supplying this region. It gives perforating branches to overlying skin and subcutaneous tissue. The facial artery is a branch of external carotid and runs a sinous course. It appears on the face at the antero-inferior border of masseter by turning around the lower border of mandible and then runs antero-superiorly up to 1.5 cm from the angle of mouth and then vertically to end near the medial angle of eye [1]. The subdermal vascular plexus formed by facial, angular, transverse cervical and infraorbital vessels provides th
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