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A Comparison of Flap Dynamics in Human Cadavers

Richard Abraham Zoumalan, MD; Carole Hazan, MD; Vicki J. Levine, MD; Anil R. Shah, MD

Arch Facial Plast Surg. 2008;10(3):181-185.

Objective  To determine whether differences of angles between the alar rim and the long axis of the secondary defect in a Zitelli bilobed flap affect alar displacement in a fresh cadaver model.

Methods  In fresh cadaver heads, identical, unilateral 1-cm circular defects were created at the superior alar margin. Three different laterally based bilobed flap templates for reconstruction were used. One template, used on 3 cadavers, had an angle of 60° between the alar rim and the long axis of the secondary defect. Another template, used on 3 cadavers, had an angle of 90°. The last template had an angle of 135° and was used on 2 cadavers. Photographs were taken before the repair and after with the camera and cadaver heads in the same spatial relationship to each other.

Results  In the 3 cadavers that had repair using an angle of 60°, all cadavers experienced alar retraction, with a mean displacement of 1.3 mm. This was not a statistically significant change (P = .07). In the defects that had repair using an angle of 90°, there was also no significant alar displacement (P = .72). In the 2 cadavers that underwent repair using an angle of 135°, both ala underwent depression by 1.0 mm. When the differences achieved between the different angles were compared, there was a significant difference in measured distortion between the cadavers that had 90° and 60° vector placement (P = .02). There were no measurable changes to the contralateral maximal nostril distance.

Conclusions  Vector alignment can have an impact on nostril displacement. In bilobed flaps, the axis of the secondary defect may play an important role. This study suggests that secondary defects aligned perpendicular to the nostril have the least amount of alar distortion.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Division of Facial Plastic Surgery (Drs Zoumalan and Shah), and Department of Dermatology (Drs Hazan and Levine), New York University School of Medicine, New York.

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