Case 3: Rieger-Marchac Dorsal Nasal Flap Revisited: An Old But Versatile Flap for Nasal Reconstruction
Pavitra Ramasamy1, Koh Khai Luen1, Mohammad Ali Mat Zain1, Wan Azman Wan Sulaiman1
- 1Universiti Sains, Malaysia
Abstract
Keywords: Nasal reconstruction, plastic, surgery, tumor reconstruction, rieger-marchac Authors: Pavitra Ramasamy, Koh Khai Luen, Mohammad Ali Mat Zain, Wan Azman Wan Sulaiman. Institution: Universiti Sains, Malaysia Abstract Reconstructing the nasal tip and lower third defects after neoplasm excision is challenging due to the nose’s complex structure. We present an 82-year-old man with basal cell carcinoma at the nasal tip-alar junction. Following surgical excision with a 3mm margin, the full-thickness defect was reconstructed using the Rieger-Marchac dorsal nasal flap. This technique effectively restores nasal form and function while ensuring optimal aesthetic outcomes, making it a reliable approach for nasal defect repair. Patient medical history Hypertension, diabetic mellitus, bronchial asthma, recent history of burrhole and drainage of subdural haemorrhage post fall and chronic smoker. Before and After Patient examination He presented with hyperpigmented lesions at the junction between nasal tip and the right alar of the nose for more than 10 years. It was initially a small mole like lesion which increase in size progressively in past 1 year. It was also associated with contact bleeding (Figure 1). The 2.0 x 2.0cm infiltrative, pearly lesion extended from right nasal supratip to the right alar groove. No evidence of transnasal involvement however ulceration was observed Pre-operative considerations Patient evaluation includes medical history to assess comorbidities like smoking that may affect healing Confirm complete tumor excision with frozen section or histopathology Consider nasal symmetry, contour and airway patency which may affect the functional concerns The defect need to be evaluated. Typically used for detects on the nasal septum, tip or sidewalls, need to consider adjacent tissue laxity for optimal flap mobilization Surgical planning of flap design on the superiorly based dorsal nasal flap consideration tension and vascularity and assess how to closu
BeforeAfterHypertension, diabetic mellitus, bronchial asthma, recent history of burrhole and drainage of subdural haemorrhage post fall and chronic smoker.
The surgical resection created a full-thickness defect that involved the half of nasal tip, soft triangle, nasal lobule and distal part of dorsum. The donor site flap was designed and marked
The flap was raised starting at the flap edge at the subcutaneous plane, then deepened to submuscular plane to include muscle perforator from the angular vessels. The flap was designed in such a way that the medial edge is thin to contour at the medial epicanthal and side wall to reduce the pincushioning effect and achieve less visible scar
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The flap was then rotated to cover the defect and sutured
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Lateral view with passive penrose drain
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Anterior view
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Lateral view
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Anterior view
Patient was happy and satisfied with outcome and defaulted follow up
Photo was sent by patient via WhatsApp
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Flap Monitoring: Check colour, capillary refill, and temperature every few hours. Venous congestion (dark, sluggish, swollen flap) → Consider gentle massage or suture release.
How to cite this article
Pavitra Ramasamy, Koh Khai Luen, Mohammad Ali Mat Zain, Wan Azman Wan Sulaiman. Case 3: Rieger-Marchac Dorsal Nasal Flap Revisited: An Old But Versatile Flap for Nasal Reconstruction. Journal of Plastic, Breast & Reconstructive Surgery. 2025.
Open access. © 2025 The Author(s). Published by the Journal of Plastic, Breast & Reconstructive Surgery. Copyright to this case is shared between the author(s) and the journal; authors may reuse their own case for education, presentations and social media.
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