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Original Investigation
July 3, 2019

Use of a Lateral Extended Nasal Island Flap for Nasal Reconstruction

Author Affiliations
  • 1Skin Cancer and Reconstructive Surgery Center, Newport Beach, California
JAMA Facial Plast Surg. 2019;21(5):434-439. doi:10.1001/jamafacial.2019.0423
Key Points

Question  What is the application of the lateral extended nasal island (LENI) flap and its cosmetic outcome in nasal reconstruction?

Findings  This retrospective case series study of 82 patients who underwent the LENI flap procedure found that the LENI flap is a reliable single-stage reconstruction for various nasal defects including the nasal tip, bridging distances up to 1.8 cm.

Meaning  The lateral extended nasal island flap is an effective and predictable single-stage reconstructive technique for medium-size nasal tip defects.


Importance  Small and medium nasal defects of the nose have been treated mostly with local skin flaps and skin grafts producing variable aesthetic outcomes. The lateral extended nasal island (LENI) myocutaneous flap provides a reliable single-stage reconstruction for small to medium nasal defects, including those in the nasal tip, with excellent cosmetic results.

Objective  To describe and define a new version of the lateral nasal island flap for small to medium nasal defects.

Design, Setting, and Participants  This retrospective case series included all patients who had undergone reconstruction with the lateral nasal island flaps and LENI flaps from October 2009 to July 2018 with 97 consecutive cases studied. Indications for surgery were mostly skin cancer defects. The analysis was performed from January 1, 2018, through December 15, 2018.

Main Outcomes and Measures  The location and the size of the defects were defined. Number of stages required to achieve functional and aesthetic goals was reported. Appearance rating after the first stage was assessed.

Results  The case series included 82 patients (mean age, 64 years [range, 31-90 years]; 36 [43%] women and 46 [57%] men). These 82 patients’ flaps qualified as the LENI flap. Of these, 54 (65%) were used for nasal tip reconstruction. The flap advancing distance ranged from 0.7 cm to 1.8 cm (mean advancing distance, 1.2 cm). Of 67 patients with available postoperative photographic documentation, 44 had mild or undetectable signs of reconstruction, 21 had visible scars, and 3 had obvious deformities. A single-stage procedure was performed in 66 cases, 2 stages in 15 cases, and 3 stages in 2 cases.

Conclusions and Relevance  The LENI myocutaneous flap is a reliable technique for reconstruction of nasal defects up to 1.8 cm. The extended dissection and release of the flap at piriform aperture achieves the predictable outcome and separates it from the previously described lateral nasal island flaps.

Level of Evidence  4.