Alternatives in nasal reconstruction ("five flaps and a graft").

Five pedicle flaps and one auricular composite graft deserve increased use and attention in nasal reconstructive surgery. All have in common the high possibility of superior functional and esthetic results while requiring the payment of a minimum penalty of tissue sacrifice. A composite graft of conchal cartilage and adherent post-auricular skin serves well in the saddle nose deformity of childhood, creating satisfactory tissue augmentation and recreating cartilaginous support for the airway. The sublabial mucosa of the upper lip provides superior tissue for pedicle flap repair of nasal septal perforations. Tunneled through a small oronasal fistula, the flap is elevated and transposed as a one-stage procedure. No closure of the donor site is required. Forehead flaps derived from the precise midline or the non-hair-bearing bay of forehead skin (the sickle flap), are useful, non-delayed flaps carrying considerable tissue of superior color match to nasal defects. A major advantage is the excellent camouflage possible at either donor site area. When nasal reconstruction of greater dimensions becomes necessary, the scalping flap is advantageous. Flap reliability is of a high order, and flap blood supply is unequaled.