Journal of Plastic, Breast & Reconstructive Surgery·经同行评审的开放获取外科病例报告同行评审 · 开放获取
Pavitra Ramasamy, Koh Khai Luen, Mohammad Ali Mat Zain, Wan Azman Wan Sulaiman. Case 3: Rieger-Marchac Dorsal Nasal Flap Revisited: An Old But Versatile Flap for Nasal Reconstruction. Journal of Plastic, Breast & Reconstructive Surgery. 2025.
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Pavitra Ramasamy1, Koh Khai Luen1, Mohammad Ali Mat Zain1, Wan Azman Wan Sulaiman1
Reconstructing the nasal tip and lower third defects after neoplasm excision is challenging due to the nose’s complex structure. We present an 82-year-old man with basal cell carcinoma at the nasal tip-alar junction. Following surgical excision with a 3mm margin, the full-thickness defect was reconstructed using the Rieger-Marchac dorsal nasal flap. This technique effectively restores nasal form and function while ensuring optimal aesthetic outcomes, making it a reliable approach for nasal defect repair. Patient medical history Hypertension, diabetic mellitus, bronchial asthma, recent history of burrhole and drainage of subdural haemorrhage post fall and chronic smoker. Before and After Patient examination He presented with hyperpigmented lesions at the junction between nasal tip and the right alar of the nose for more than 10 years. It was initially a small mole like lesion which increase in size progressively in past 1 year. It was also associated with contact bleeding (Figure 1). The 2.0 x 2.0cm infiltrative, pearly lesion extended from right nasal supratip to the right alar groove. No evidence of transnasal involvement however ulceration was observed Pre-operative considerations Patient evaluation includes medical history to assess comorbidities like smoking that may affect healing Confirm complete tumor excision with frozen section or histopathology Consider nasal symmetry, contour and airway patency which may affect the functional concerns The defect need to be evaluated. Typically used for detects on the nasal septum, tip or sidewalls, need to consider adjacent tissue laxity for optimal flap mobilization Surgical planning of flap design on the superiorly based dorsal nasal flap consideration tension and vascularity and assess how to closu
BeforeAfterHypertension, diabetic mellitus, bronchial asthma, recent history of burrhole and drainage of subdural haemorrhage post fall and chronic smoker.
He presented with hyperpigmented lesions at the junction between nasal tip and the right alar of the nose for more than 10 years. It was initially a small mole like lesion which increase in size progressively in past 1 year. It was also associated with contact bleeding (Figure 1). The 2.0 x 2.0cm infiltrative, pearly lesion extended from right nasal supratip to the right alar groove. No evidence of transnasal involvement however ulceration was observed
Patient evaluation includes medical history to assess comorbidities like smoking that may affect healing
The surgical resection created a full-thickness defect that involved the half of nasal tip, soft triangle, nasal lobule and distal part of dorsum. The donor site flap was designed and marked
The flap was raised starting at the flap edge at the subcutaneous plane, then deepened to submuscular plane to include muscle perforator from the angular vessels. The flap was designed in such a way that the medial edge is thin to contour at the medial epicanthal and side wall to reduce the pincushioning effect and achieve less visible scar
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The flap was then rotated to cover the defect and sutured
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Lateral view with passive penrose drain
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Anterior view
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Lateral view
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Anterior view
Patient was happy and satisfied with outcome and defaulted follow up
Photo was sent by patient via WhatsApp
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Flap Monitoring: Check colour, capillary refill, and temperature every few hours. Venous congestion (dark, sluggish, swollen flap) → Consider gentle massage or suture release.
