Local flaps for reconstruction of nasal defects

Background: The skin over the nose is not relatively less mobile for primary closure of nasal defects. In addition to skin grafts and secondary intention healing, there are various local flap techniques available for the reconstruction of nasal defects. Objective: The aim of this study was to assess the effectiveness and the cosmetic consequences of various local flap techniques in reconstructing nasal defects. Methods: Between December 2002 and April 2004, 18 patients were treated with a local flap technique for the reconstruction of a nasal skin defect following Mohs micrographic surgery. The post-operative result of each case was rated with serial clinical photographs and medical records by two independent physicians. Results: The nasal skin defects were reconstructed with various local flaps, such as the nasolabial interpolation flap, bilobed flap, glabellar flap, median forehead flap, and subcutaneous island pedicle flap. The cosmetic and functional results of the nasal reconstructions were judged to be generally satisfactory, excluding a trapdoor deformity in one patient, and eyebrow distortion and cancer recurrence in another patient. The cosmetic results of the cases reconstructed with a subcutaneous island pedicle flap were favorable in color and texture of the flaps, and incision scar formation, compared to the other techniques used. Conclusion: There are various local flap techniques which can be used in the reconstruction of nasal defects, and each of them has its own merits and drawbacks. The reconstructive plan should be customized to the patient considering not only the size, depth and location of the defect but also the medical history of the patient, the patients expectations, and the surgeons experience. Reconstruction with a subcutaneous island pedicle flap has been found to be one of the most effective methods, and allows the surgeon to spend a relatively short time in reconstructing defects of the upper and lower part of the nose. Furthermore, it has many advantages over the skin graft and other local flap techniques, especially with the aesthetic result.