Case 09 2026: Single-Stage Spear Flap Reconstruction of Recurrent Full-Thickness Nasal Alar Defects: A Two-Case Series

Keywords: Spear flap; nasolabial turnover flap; nasal ala reconstruction; basal cell carcinoma; case series Authors: Lukas Kure-Rosenberg, Matilda Svenning, Mille Vissing. Magnus Balslev Avnstorp Abstract Background: Reconstructing the full thickness of the nasal ala is technically challenging because it requires restoring contour, lining, and airway patency all at once. The Spear flap, also known as the nasolabial turnover flap, remains a useful single-stage option for selected lateral alar defects. Cases: Two elderly women presented with recurrent basal cell carcinoma of the ala nasi following multiple prior curettages. In case 1, excision resulted in a 20 × 12 mm through-and-through alar defect. In case 2, a recurrent lesion on the left alar measuring 11 × 8 mm initially required staged margin control before final reconstruction. Technique: Both defects were reconstructed using a cheek-based Spear flap after frozen-section-guided excision. Flap design was customized to recreate internal lining and external coverage while minimizing distortion of the alar rim and vestibule. Results: Both flaps remained viable, with no evidence of ischemia or venous congestion. Case 1 achieved complete oncologic clearance and healed with a stable contour; mild residual vestibular fullness did not warrant revision. In case 2, staged clearance allowed for delayed single stage inset, and early healing proceeded without complications. Conclusion: For recurrent through-and-through alar defects, the Spear flap is a reliable and practical reconstructive option. Especially in elderly patients with comorbidities or competing health issues, it provides dependable vascularity, good tissue match, and restores the alar subunit without the complexity of multi-stage procedures. Patient medical history Case 1 (left image) A 90-year-old woman was referred for recurrent basal cell carcinoma of the ala nasi after multiple previous curettages performed in a private dermatology practice in october 2025