Combination of Nasolabial V-Y Advancement Flap and Glabellar Subcutaneous Pedicled Flap for Reconstruction of Medial Canthal Defect
A 77-year-old woman presented with a 1-year history of a black tumor in the right medial canthal region. The tumor measured 3 × 5 mm at the first examination. An incisional biopsy revealed that the tumor was a basal cell carcinoma.\nWe excised the tumor with a 4-mm safety margin (fig. ). The defect included the areas superior and inferior to the MCT and was adjacent to the medial eyelid commissure (fig. ). We planned to separately reconstruct the upper and lower parts of the defect using a nasolabial V-Y advancement flap and a glabellar subcutaneous pedicled flap (fig. ). We first advanced the nasolabial V-Y flap from the inferior aspect to create an elliptic defect in the upper part and fixed it to the dermis using 6-0 PDS® II sutures (Johnson & Johnson K.K., Tokyo, Japan) (fig. ). We then created a glabellar subcutaneous pedicled flap to match the residual upper elliptic defect with the major axis set along a relaxed skin tension line (fig. ). A subcutaneous tunnel was made between the flap and the defect, and the flap was passed through the tunnel to the upper residual defect (fig. ). The resultant defect in the glabella was closed in a dermostitch fashion with 6-0 PDS® II (fig. ). Each flap was anchored to the MCT to create a concavity in the medial canthal region. The skin was sutured with interrupted 6-0 polyvinylidene fluoride sutures (Asflex®; Kono Seisakusho Co., Ltd., Tokyo, Japan) (fig. ).\nThe excised tissue margin was histopathologically free of tumor cells. At 6 months postoperatively, no tumor recurrence or deformity was evident, and only an inconspicuous scar was present (fig. ).