Reconstruction of lateral nasal defects.

In planning reconstruction of a lateral nasal soft tissue defect, the surgeon should be aware of alternative methods and select the one most appropriate for the patient. Variables to be considered include the extent, depth, and location of the defect, the age, sex, and tissue laxity of the patient, and the availability of donor tissue. Surface defects are often best corrected with full-thickness skin grafts: upper eyelid, preauricular, postauricular, or supraclavicular, depending on which portion of the nose is being treated. Anterior superior helix composite grafts serve quite nicely to restore full-thickness alar losses, and other such defects are better reconstructed with a nasolabial flap. The midline forehead flap is quite useful but in certain situations has drawbacks. For larger skin and soft tissue defects, a transverse forehead flap based on the superficial temporal vessel provides appropriate reconstruction.