Complex Nasal Reconstruction With Free Superficial Circumflex Iliac Artery/Inferior Epigastric Artery Flaps and Exteriorized Skin-grafted Pedicles.

Reconstruction of extensive nasal defects is technically demanding due to the nose's aesthetic importance and intricate 3-dimensional structure. The gold standard for nasal reconstruction typically involves local flaps, with or without the addition of free flaps, depending on the defect's extent and complexity. In cases where conventional reconstructive options are unavailable, innovative approaches may be considered. A 79-year-old woman presented with a large nasal defect following the excision of an extensive basal cell carcinoma and multiple failed reconstruction attempts. Due to the unavailability of pedicled forehead flaps, an alternative approach was adopted using abdominal free skin flaps, specifically, a flap based on the superficial branch of the superficial circumflex iliac artery, followed by a flap based on the superficial inferior epigastric artery, incorporating an exteriorized skin-grafted pedicle to minimize further damage to facial tissues. This approach achieved nasal reconstruction with satisfactory aesthetic and functional outcomes by using redundant abdominal skin, while avoiding the use of large local facial flaps that could have resulted in additional tissue injury and distortion. Abdominal skin represents a promising donor site for flaps in the reconstruction of complex nasal defects. Although the exteriorized skin-grafted pedicle technique carries inherent risks, it warrants further investigation as a potentially valuable advancement in the reconstructive armamentarium.