الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Alar reconstruction remains one of the most challenging aspects of facial plastic surgery. Considerations of complex skin contours, cutaneous color, and texture take on unique nuances when trying to achieve a functional airway overlying a 3-dimensional structural framework.
Various reconstruction methods including local flaps, forehead flaps, composite grafts, and free flaps have been reported to be used in the repair of nasal alar defects. The defect size, symmetry, color harmony with the surrounding tissues, skin texture, and donor area are important factors to be considered in nasal alar reconstructions.
One of the oldest classic methods used in nasal alar reconstructions is the nasolabial flap. Since its first use in nasal reconstructions, various modifications of this flap have been reported like to be applied in folded or non-folded forms.
The present work included 10 cases with nasal alar full thickness defect presented in The Plastic Surgery Department, Minia University Hospital in period between October 2018 till June 2019.
Their ages ranged from 4-70 years old with an average age 47.8 years. Seven of them were males and three were females. The etiology of alar defects was traumatic in 1 patient and post ablative in 9 patients. One case had isolated alar defect, 6 cases had alar extension to nasal sidewall, one case had alar extension to upper lip, one case had alar extension to dorsum of the nose and one case had alar extension to peri-alar region.
The protocol of management of nasal alar full thickness defects in this study included surgical reconstruction by folded nasolabial flap.
According to results 60% of patients had Good results, 30% had Excellent results with excellent functional and esthetic outcome, only 10% of cases had fair results with bulky flap and alar retraction, they needed second stage of debulking and cartilage graft and no one (0%) had poor results.
Patient satisfaction was achieved in 90% of cases as regarding full tissue and color harmony, good vascularization, minimal donor site morbidity by the less conspicuous donor site scar which well placed in the nasolabial fold, adequate framework support without cartilage graft, and single-session reconstruction.
Conclusion and Recommendations
On conclusion, the folded nasolabial flap is a very good option for the reconstruction of full-thickness alar defects involving the alar margin. Because of good vascularization, minimal donor site morbidity, adequate framework support without cartilage graft, and single-session reconstruction.
This surgical technique is simple, secure method enabling full tissue and color harmony. The overall success of the flap and the cosmetic result were excellent specially in diabetics and smokers.
We recommend the use of the folded nasolabial flap in the reconstruction of full-thickness alar defects involving the alar margin only or extending to peri-alar regions.