Case 8: Perialar Crescentic Advancement Flap for Nasal Reconstruction
Lukas Kure-Rosenberg1, MD, Chief1
- 1Department of Plastic Surgery, Zealand University Hospital, Denmark
Abstract
Keywords: Nasal reconstruction, perialar flap, crescentic, advancement, PCC in situ. Authors: Lukas Kure-Rosenberg, MD and Nicco Krezdorn, MD, Chief. Institution: Department of Plastic Surgery, Zealand University Hospital, Denmark. Abstract We present the case of a 68-year-old woman with a residual PCC in situ on the nasal dorsum following initial excision and open defect by colleague. The initial pathology revealed incompletely excised changes cranial to the primary defect (12 o’clock position). The patient was booked for re-excision and closure, originally planned with a full-thickness skin graft (FTSG). However, the patient expressed high cosmetic expectations, prompting a change in plan to a local flap-based reconstruction. A perialar crescentic advancement flap was chosen, utilizing the planned re-excision site, which anatomically corresponded to a burrow triangle in the flap design. This case illustrates how integrating oncologic and reconstructive planning can optimize both margin control and aesthetic outcomes. Patient medical history A 68-year-old woman was referred for further management of an ulcerating lesion, consistent with biopsy-confirmed squamous cell carcinoma (SCC/PCC) in situ on the nasal dorsum. The patient was routinely seen at dermatological checkups due to being kidney transplanted, and was therefore also recommended surgical management of the lesion. The lesion was initially excised by a colleague and left as an open wound for secondary intention until the final pathological analysis. Pathology demonstrated no invasive tumor, but histopathological evaluation revealed residual SCC in situ/atypical changes at the superior (12 o'clock) margin of the excised area, necessitating re-excision. Before and After Patient examination Upon reexamination, the surgical defect was located centrally on the nasal dorsum, cranial to the supratip area, measuring 12 mm in diameter. The previously excised region had demarcated edges and healthy granulation tissu
Baker SR. Local Flaps in Facial Reconstruction. 3rd ed. Elsevier; 2014.Zitelli JA. The crescentic advancement flap. Arch Dermatol. 1989;125(7):957–959.Burget GC, Menick FJ. Aesthetic Reconstruction of the Nose. Mosby; 1994.Park SS. Local flaps: cheek and perinasal reconstruction. Facial Plast Surg Clin North Am. 2011;19(1):107–120.Rohrich RJ, Muzaffar AR, Janis JE. The Anatomy and Applications of the Nasolabial Flap. Plast Reconstr Surg. 2003;111(2):811–822.
BeforeAfterA 68-year-old woman was referred for further management of an ulcerating lesion, consistent with biopsy-confirmed squamous cell carcinoma (SCC/PCC) in situ on the nasal dorsum. The patient was routinely seen at dermatological checkups due to being kidney transplanted, and was therefore also recommended surgical management of the lesion. The lesion was initially excised by a colleague and left as an open wound for secondary intention until the final pathological analysis. Pathology demonstrated no invasive tumor, but histopathological evaluation revealed residual SCC in situ/atypical changes at the superior (12 o'clock) margin of the excised area, necessitating re-excision.
Initial lesion (left and central picture) and open wound following primary excision (right picture).
All surgery was carried out in an out-patient setting. The nose was preoperatively numbed with local anesthesia (LA) with adrenaline in a combined nerve block of the infraorbital nerve (V2) and infiltration. The surgical site was cleansed with an antiseptic solution to achieve sterile conditions.
A perialar crescentic flap was designed and raised along the alar groove, extending into the melolabial fold. The flap was undermined and advanced medially. The superior burrow triangle, which overlapped with the re-excision site, was performed with a good margin (>3mm) and marked for histopathological analysis. Closure was completed in layers with 5-0 Vicryl and 5-0 Prolene sutures.
Re-excision at the cranial 12 o’clock position contained within the burrow triangle of the chosen flap design (left picture). Excision of the burrow triangle (central left picture). Raising the flap (central right picture), until sufficient tension-free coverage of the widest part of the defect (right picture).
2
The reconstruction and flap demonstrated good cosmesis and vascular perfusion immediately postoperatively, with no bleeding or complications. The patient was discharged and scheduled for suture removal at the outpatient clinic 7 days post-surgery.
3
On postoperative day 7, the flap demonstrated excellent perfusion with mild expected edema. Some signs of infection were noted, so the patient started a 5-day oral antibiotic course. Suture removal was carried out at this visit. At the 3-month follow-up, the patient showed minimal scarring with excellent color match and contour. No contractures or distortion were present, and the patient was pleased with the result.
4
Results 3 months postoperatively, showing complete healing and excellent cosmesis.
5
This case demonstrates how re-excision of residual tumor can effectively be combined with aesthetic reconstruction in nasal plastic surgery. The use of a perialar crescentic advancement flap provided a single-stage solution that addressed both oncologic safety and patient satisfaction.
How to cite this article
Lukas Kure-Rosenberg, MD, Chief. Case 8: Perialar Crescentic Advancement 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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