A Congenital Alar Defect and Its Reconstruction

Congenital anomalies of the nose are very rare and include the bifid nose, complete absence of the nose, and unilateral absence of the nose.
A 23-year-old medical school student was diagnosed with a rare congenital nasal anomaly including left alar full-thickness defect.
Under general anesthesia, a posteroinferiorly based V-Y flap was selected to cover the outer surface. To make the inner lining, another anteroinferiorly based V-Y flap from the internal coverage tissue was elevated, including alar cartilages remnants and soft tissues around it. These two V-Y flaps were called double-opposing V-Y flaps. To support the alar wing, a cartilaginous graft was inserted taken from the anterior septal edge.
The treatments of the nasal alar defects resulting from oncological surgery and those from congenital anomalies significantly differ. The expectations of the patients from the surgery are higher in the second situation than in the first one. A technique using minimal donor site morbidity should be searched.