Nasolabial flap final

technique of nasolabial flap

1. Nasolabial Flap/ Melolabial Flap Jameel kifayatullah

2. vascular supply The vascular supply of this region is derived from perforating branches of the facial artery inferiorly, and angular artery superiorly The superiorly based flap is supplied by perforators from the facial and angular arteries The inferiorly based flap is supplied by branches of the facial artery

3. USES Superiorly based nasolabial flaps can be used for reconstruction of nasal, lower eyelid, and cheek defects whereas inferiorly based flaps are considered appropriate in reconstruction of defects of the lip, oral commissure and anterior oral cavity

4. Uses Reconstruction of oro-antral fistulae Coverage of small surrounding cutaneous defects of the cheek and nose Coverage of intraoral defects of the anterior floor of the mouth in edentulous patients When prior reconstructive efforts have failed and simple reconstruction is advantageous

5. contraindications Prior facial incisions, Scars local flap harvest sites Previous surgery neck dissection, radiation therapy

6. NASOLABIAL FOLD

7. Nasolabial flaps based on the location of the pedicle. a, superiorly based. b, Inferiorly based c)centrally based.  

8. Flap dimensions Before flap harvest, the length requirement and the arc of rotation of the flap must be considered to avoid distal necrosis. Necrosis occurs from excessive length of the flap, from tension on the flap, or from constriction of the arterial supply or venous outflow. Once the dimensions of the defect are established, plans for harvesting the nasolabial flap can be made. A simple technique to determine whether the nasolabial flap will reach the defect with an acceptable amount of tension is to use a piece of gauze to simulate the length, width, and rotation of the nasolabial flap. By holding one end of the gauze at the base of the flap, the gauze can be rotated to simulate rotation of the flap. The flap can then be outlined This flap design allow a flap length of 5-7cm while width of the flap could be of up to 3-5cm as per requirement of the defect

9. Flap markings For oral cavity reconstruction, the use of an inferiorly based nasolabial flap is preferred. The medial incision line precisely follows the nasofacial fold in its superior two thirds and is located 3 to 4 mm medial to the nasolabial fold in its inferior third The base of the flap should be 1.5 to 2.5 cm in width The medial and lateral limbs of the incision taper together superiorly approximately 0.5 to 0.75 cm anterior to the medial canthus . The inferior limit of the flap is at the level of the oral commissure

10. Flap markings Placing the inferior one third to one half of the nasolabial portion of the incision medial to the fold will allow for an improved arc of rotation and aesthetic result

11. technique

12. T echnique With the planning completed, the flap is raised from superior to inferior in a supramuscular plane by using dissecting scissors. The angular branch of the facial artery often needs to be tied off in the superioraspect of the dissection . The transbuccal tunnel is made according to the site of the defect in the oral cavity For the single-stage procedure, those parts of the flap pedicle were de- epithelialized carefully which were placed in the tunnel The tunnel should be large enough to easily accommodate 1 or 2 fingers (1.5 to 2.0 cm ). The flap is then transferred into the oral cavity in a tension-free manner and inset with a series of interrupted 3-0 absorbable sutures.

13. Nasolabial Flap Flap raised in a supramuscular plane of dissection and the inferior 2 cm deepithelialized in preparation for single-stage transfer

14. Advantages The ease of harvest, robust blood supply versatility of the flap Close proximity Excellent color Texture Thickness match to adjacent facial structures Scar hidden within melolabial fold

15. Disadvantages Limited donor tissue Facial scarring Second surgical procedure Difficult to use in dentate patients

16. Complications Infection minor or major flap necrosis wound dehiscence Donor site morbidity( Asymmetry at the level of the nasolabial fold)