Reconstruction of complex nasal dorsal and sidewall defects: is the nasal sidewall subunit necessary?

OBJECTIVE

To demonstrate that by the extended use of cheek advancement flaps, the need to maintain the nasal dorsal side unit is obviated.

DESIGN

Retrospective case series.

SETTING

Tertiary care clinic and hospital.

PATIENTS

Twelve patients aged 48 to 88 years who underwent Mohs micrographic surgery for nasal skin neoplasms, presenting with dorsal sidewall and nasal dorsal cutaneous defects.

INTERVENTION

All patients underwent nasal reconstruction with adjacent tissue cheek advancement flaps with or without contralateral nasal dorsal and sidewall advancement flaps.

MAIN OUTCOME MEASURES

Avoidance of ipsilateral nasal sidewall scars to allow a natural-appearing transition between the cheek and nose and avoidance of forehead flap morbidity. Results Satisfactory results were achieved in all but 1 patient who had partial flap necrosis.

CONCLUSIONS

To maintain the nasal dorsal sidewall unit, superior, central dorsal, and nasal sidewall defects have traditionally been reconstructed using a variety of techniques, including skin grafts and regional flaps, such as glabellar flaps and frontal flaps. We demonstrate that creation of the nasal dorsal sidewall unit is often not necessary, and excellent results can be achieved through the expanded use of cheek advancement flaps.