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The Utility of Alar Rim Grafts in Bilobed Flap Nasal Reconstruction
Elizabeth Berggren
1, Rhys Richmond
2, Yan Lee
2, Jonathan Lee
1
1UMass Chan Medical School - Baystate, Springfield, MA, 2Yale Medical School, New Haven, CT
Background: Bilobed flaps for nasal alar defects can be associated with characteristic changes in nasal shape and symmetry, including tip deviation and alar retraction. Alar rim and subalar cartilage grafts have been documented to improve nasal symmetry in rhinoplasty. We sought to investigate whether the use of an alar rim graft in conjunction with a bilobed flap improves nasal symmetry after reconstruction.
Methods: Retrospective review of 27 patients presenting to a single institution who had a unilateral nasal alar reconstruction with a bilobed flap after Mohs resection. Measurements performed using Adobe Photoshop. The Submental Nasal Appearance Scale (SNAS) was used to evaluate all preoperative/postoperative photographs. Wilcoxon Signed-Rank tests were used for within-technique pre/post comparison and Mann-Whitney U tests were used to compare pre/post change between techniques for each SNAS category. All analyses were conducted in R version 4.2.2.
Results: The bilobed flap alone was associated with a significant change in SNAS score postoperatively for nasal outline symmetry (P=0.008) and nostril outline symmetry (P=0.016), indicating an overall decline in aesthetic result from preoperative appearance. However, there was no significant difference in postoperative SNAS scores observed in the bilobed flap with alar rim graft group.
Conclusion: This study found that the use of an alar rim graft in conjunction with a bilobed flap was associated with a better aesthetic outcome than the use of a bilobed flap alone according to SNAS scores. This suggests that alar rim grafts could be used to improve nasal symmetry and minimize deformities associated with local flaps for nasal alar reconstruction.
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