Reconstruction Experience Using Logarithmic Spiral Flap on the Nasal Sidewall
Annals of Dermatology
Dear Editor: The lower nasal sidewall including nasal ala is a flat-toconcave anatomical subunit for which a poorly designed reconstruction has potential to cause disfiguration or asymmetry of the alar rim 1 . The reconstruction method of a skin defect in the nasal ala should be chosen depending on the location and size of the lesion for best results. A rotation flap, nasofacial interpolation flap and banner transposition flap are used for medium to large sized defects of the nasal ala 2 .
... ugh these flaps can cause asymmetry of the nasal ala or blunting of nasofacial sulcus, a logarithmic spiral flap achieves better functional and cosmetic results in reconstruction of nasal alar defect 3 . Herein, we present an operational experience of basal cell carcinoma (BCC) on the nasal ala reconstructed with a logarithmic spiral flap. A 56-year-old male presented with a 0.7-cm-sized, blackish, irregular bordered papule on the left lower nasal sidewall that had been present for 3 years (Fig. 1A ). The size of the lesion had continuously increased during the period. Dermoscopic examination showed multiple bluish to grayish ovoid nests and blue-white veil-like structures, typical findings of BCC (Fig. 1C) . We received the patient's consent form about publishing all photographic materials. Histopathologic examination also revealed typical features of BCC including basaloid tumor cell nests and peripheral palisading retraction spaces (Fig. 1D ). On the operating table, wide excision of the tumor mass with a generous tumor-free margin created a 1.3-cm-sized circular skin defect. A logarithmic spiral flap was designed with a superior pedicle to hide part of the scar line in the alar nasal sulcus (Fig. 2) . The flap was dissected in the subcutaneous plane and medially rotated parallel to the nasofacial sulcus. The dermal layer of the flap was sutured with 6-0 vicryl, and the skin was sutured with 6-0 silk. The final shape and texture of the repaired area were satisfactory (Fig. 1B) . There was no hypertophic change of nasal mucosa and the nasal symmetry was preserved. No local recurrence or regional metastasis was observed for 3 months. Mahlberg et al. 4 reported that the spiral flap is a reproducible one-stage flap for small-to medium-sized defects of the nasal ala and alar groove with minimal risk of aesthetic or functional complication and can also provide volume, color, and texture match in the repair of a skin defect. Among the many types of spiral flaps, the logarithmic spiral flap with an increasing spiral width can provide a wide vascular inlet and minimize the secondary defect along the edge of the flap 3,4 . Usually, a spiral flap is used for defects ranging in diameter from 0.5 to 1.5 cm and the logarithmic spiral flap can be used safer than the spiral flap 3,4 . In our case, the incision line and logarithmic spiral flap were well-contoured into natural lines and produced no disfiguration or traction in the Asian subject. Our experience suggests that the logarithmic spiral flap can be a surgical option for a lower nasal sidewall defect or nasal ala reconstruction in Asian surgical candidates.