Nasalis myocutaneous island pedicle flap with bilevel undermining for repair of lateral nasal defects

BACKGROUND. The superiorly based nasalis myocutaneous island pedicle flap with bilevel undermining is a recently described bipedicled flap used for repair of nasal tip and supratip defects. This flap was used for the repair of small to medium-size defects of the nasal tip and supratip regions. OBJECTIVE. To describe a single-pedicled modification of this flap for the reconstruction of lateral nasal defects at or above the alar groove. METHODS. With the use of diagrams and fresh cadaver dissection, we demonstrate the method of preparing, raising, and placement of this new flap. We further elucidate in an illustrative way the efficacy of bilevel undermining as it is used for achieving greater flap mobility. Finally, we show representative cases with pre- and postoperative results. RESULTS. We describe the senior author’s 4-year experience in the development of this flap. CONCLUSION. The nasalis myocutaneous island pedicle flap with bilevel undermining, a new method for repair of lateral nasal defects at or above the alar groove, yields excellent functional and cosmetic results. Bilevel undermining is a new and valuable method of achieving greater tissue mobility in muscle-based flaps