Contributing effect of lymphatic disruption in trapdoor deformity in nasolabial flaps—superiorly based vs. inferiorly based flap: A case report

The nasolabial flap is well suited for reconstruction of the lower third of the nose. In one-stage reconstruction used as transposition flap, complications can be caused by blunting of the normal concavity of the nasofacial sulcus, but also by trapdoor formation. Various theories have attempted to explain this phenomenon of bulging tissue occurring in transposition flaps. The contributing effect of lymphatic dysfunction is not clear. In our case performed after excision of basal cell carcinoma, both lower thirds of the nose of a 77-year-old patient were reconstructed with a nasolabial transposition flap using an inferior base on one and a superior base on the other side. A follow-up showed greater trapdoor deformity on the superiorly based transposition flap. Assuming that the inferiorly based flap has better drainage than the superiorly based due to intact vertical lymphatics, our case suggests that lymphatic disruption may significantly contribute to the development of trapdoor deformity.

Level of Evidence: Level V, risk/prognostic study.