Gaining Large Coverage With Small Island Pedicle Flaps in Tight Cosmetic Subunits: Taking Advantage of Rotation and Pincer Principles on the Nasal Ala

Background Island pedicle flaps (IPFs) are widely used in reconstructive surgery due to their versatility, tissue efficiency, and excellent clinical outcomes. While IPF rotations and ‘pincer flap’ modifications have previously been sparsely described, they are not often discussed in the literature. Objective We demonstrate the use of both rotating IPFs and pincer techniques for defects traditionally considered too large for classic IPF design on the nasal ala. Methods Forty-four patients underwent alar repair using the rotation or combined rotation with pincer modification to the standard IPF technique from August 2014 to May 2017. Our technique is described and case examples are presented with photographs. Results Forty-four patients with an average alar defect size of 1.2 cm underwent repair using rotation only or rotation with pincer modification of the classic IPF approach. Conclusions Reconstruction of large defects in small facial cosmetic subunits such as the nasal ala can be performed using principles of both rotating IPFs and the ‘pincer flap’ technique. The degree of rotation is directly related to the length of coverage. Modifications to the flap are straightforward to perform. Using these techniques, larger defects that previously would have been reconstructed using flaps that cross cosmetic boundaries can now be reconstructed within the same cosmetic unit, thus, improving aesthetic outcomes.