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"The Single-Stage Nasolabial Artery Perforator Flap for Nasal Reconstruction: Technique & Outcomes in 18 Cases"
Feno Monaco, BS1
Zachary A. Koenig, MD1
Majed Maalouf, MD1
1West Virginia University, Division of Plastic, Reconstructive, and Hand Surgery
West Virginia University School of Medicine
2026-01-10
Presenter: Feno Monaco
Affidavit:
This student has my permission to submit the abstract and I have confirmed the percentages of work in each category: conception and design, acquisition of data, analysis and interpretation of data, and draft and revision.
I have no financial conflicts.
Director Name: Kerri M. Woodberry, MD, MBA January 8, 2026
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background:
Reconstruction of nasal defects >2.5 cm traditionally requires two-stage regional flaps such as nasolabial, melo-labial or paramedian forehead flaps. The nasolabial perforator flap has emerged as a reliable alternative, offering excellent color and texture match, high survival rates, and versatility for large nasal defects involving multiple aesthetic subunits. Perforator-based design allows controlled dissection with improved arc of rotation and mobility, enabling simultaneous external coverage and internal lining in a single stage. This approach reduces morbidity while preserving functional and aesthetic outcomes.
Methods:
A retrospective review was performed of patients undergoing nasolabial perforator flap reconstruction at our institution between 2022 and 2025. Collected variables included demographics, defect size, reconstructed layer, complications, secondary procedures, and aesthetic and functional outcomes. All patients were followed for at least 6 months.
Results:
A total of 18 patients (mean age 69±7 years) underwent reconstruction for nasal, perinasal, and midfacial defects following Mohs surgery. Mean defect size was 3.2±0.6 cm. The flap was used for external resurfacing (propeller design) in 83.3% of cases and internal nasal lining (turnover design) in 16.7%. Complete flap survival was achieved in 100% of patients, with no necrosis, venous congestion, infection, or nasal valve compromise. Secondary contour refinement was performed in 22.2% of cases. All patients demonstrated excellent color match, durable contour, and inconspicuous donor-site scars.
Conclusions:
Nasolabial perforator flaps provide reliable, single-stage reconstruction for large nasal defects that would otherwise require multi-stage approaches. Its vascular reliability, low morbidity, and aesthetic integration make it particularly advantageous in rural or resource-limited settings.
