eMedicine Specialties > Dermatology > Surgical

Nasal Reconstruction: Multimedia

Author: Jonathan Cook, MD, Director of Dermatologic Surgery, Professor, Department of Medicine, Division of Dermatology, Duke University School of Medicine
Contributor Information and Disclosures

Updated: Jan 23, 2009

Multimedia

(Enlarge Image)

Media file 1: An apparently small recurrent basal cell carcinoma on the lateral ala (same patient as in Media File 2).

[ CLOSE WINDOW ]

An apparently small recurrent basal cell carcinoma on the lateral ala (same patient as in Media File 2).

(Enlarge Image)

Media file 2: Extensive subclinical tumor extension is identified following excision by using the Mohs micrographic surgical technique (same patient as in Media File 1).

[ CLOSE WINDOW ]

Extensive subclinical tumor extension is identified following excision by using the Mohs micrographic surgical technique (same patient as in Media File 1).

(Enlarge Image)

Media file 3: A central nasal defect of approximately 1 cm. Note that the location of the wound is in the nasal midline (same patient as in Media Files 4-5).

[ CLOSE WINDOW ]

A central nasal defect of approximately 1 cm. Note that the location of the wound is in the nasal midline (same patient as in Media Files 4-5).

(Enlarge Image)

Media file 4: Linear closure on the nasal tip. Because the diameter of the defect is small, wound-closure tension (and therefore alar distortion) is minimal (same patient as in Media Files 3 and 5).

[ CLOSE WINDOW ]

Linear closure on the nasal tip. Because the diameter of the defect is small, wound-closure tension (and therefore alar distortion) is minimal (same patient as in Media Files 3 and 5).

(Enlarge Image)

Media file 5: Linear closure on the nose 8 weeks postoperatively. Note the acceptable cicatrix and the minimal alar elevation (same patient as in Media Files 3-4).

[ CLOSE WINDOW ]

Linear closure on the nose 8 weeks postoperatively. Note the acceptable cicatrix and the minimal alar elevation (same patient as in Media Files 3-4).

(Enlarge Image)

Media file 6: Complex skin and soft tissue defect on the nasal dorsum and sidewalls (same patient as in Media Files 7-8).

[ CLOSE WINDOW ]

Complex skin and soft tissue defect on the nasal dorsum and sidewalls (same patient as in Media Files 7-8).

(Enlarge Image)

Media file 7: Glabellar and cheek components of the wound have been closed with local tissue advancement. As a result of its shallow nature and location on nonsebaceous skin, the larger nasal portion of the wound has been covered with a full-thickness skin graft (same patient as in Media Files 6 and 8).

[ CLOSE WINDOW ]

Glabellar and cheek components of the wound have been closed with local tissue advancement. As a result of its shallow nature and location on nonsebaceous skin, the larger nasal portion of the wound has been covered with a full-thickness skin graft (same patient as in Media Files 6 and 8).

(Enlarge Image)

Media file 8: The early result (8 wk) of the repair is acceptable. The slight amount of hyperpigmentation of the skin graft will likely resolve without further surgical intervention (same patient as in Media Files 6-7).

[ CLOSE WINDOW ]

The early result (8 wk) of the repair is acceptable. The slight amount of hyperpigmentation of the skin graft will likely resolve without further surgical intervention (same patient as in Media Files 6-7).

(Enlarge Image)

Media file 9: A central nasal defect that extended to the perichondrium. The patient was not interested in pedicled flap repair (same patient as in Media Files 10-11).

[ CLOSE WINDOW ]

A central nasal defect that extended to the perichondrium. The patient was not interested in pedicled flap repair (same patient as in Media Files 10-11).

(Enlarge Image)

Media file 10: A Burow graft repair diminished the size of the required graft and harvested suitable tissue from the more proximal nasal dorsum (same patient as in Media Files 9 and 11).

[ CLOSE WINDOW ]

A Burow graft repair diminished the size of the required graft and harvested suitable tissue from the more proximal nasal dorsum (same patient as in Media Files 9 and 11).

(Enlarge Image)

Media file 11: The final aesthetic result is acceptable to the patient. Note the only slight visibility of the graft (same patient as in Media Files 9-10).

[ CLOSE WINDOW ]

The final aesthetic result is acceptable to the patient. Note the only slight visibility of the graft (same patient as in Media Files 9-10).

(Enlarge Image)

Media file 12: A small Mohs defect on the nasal sidewall (same patient as in Media Files 13-14).

[ CLOSE WINDOW ]

A small Mohs defect on the nasal sidewall (same patient as in Media Files 13-14).

(Enlarge Image)

Media file 13: A rhombic flap is used to donate more available proximal nasal skin into the surgical defect (same patient as in Media Files 12 and 14).

[ CLOSE WINDOW ]

A rhombic flap is used to donate more available proximal nasal skin into the surgical defect (same patient as in Media Files 12 and 14).

(Enlarge Image)

Media file 14: At 8 weeks, the aesthetic result from the repair is excellent (same patient as in Media Files 12-13).

[ CLOSE WINDOW ]

At 8 weeks, the aesthetic result from the repair is excellent (same patient as in Media Files 12-13).

(Enlarge Image)

Media file 15: A surgical defect of approximately 1.5 cm on a sebaceous distal part of the nose (same patient as in Media Files 16-17).

[ CLOSE WINDOW ]

A surgical defect of approximately 1.5 cm on a sebaceous distal part of the nose (same patient as in Media Files 16-17).

(Enlarge Image)

Media file 16: The wound is reconstructed with a bilobed transposition flap. The distal part of the nose is not distorted because the flap is properly designed (same patient as in Media Files 15 and 17).

[ CLOSE WINDOW ]

The wound is reconstructed with a bilobed transposition flap. The distal part of the nose is not distorted because the flap is properly designed (same patient as in Media Files 15 and 17).

(Enlarge Image)

Media file 17: At 8 weeks after flap repair, the nose has healed nicely without additional intervention (same patient as in Media Files 15-16).

[ CLOSE WINDOW ]

At 8 weeks after flap repair, the nose has healed nicely without additional intervention (same patient as in Media Files 15-16).

(Enlarge Image)

Media file 18: A large surgical wound on the nasal tip. The patient desired a 1-step surgical reconstruction (same patient as in Media Files 19-20).

[ CLOSE WINDOW ]

A large surgical wound on the nasal tip. The patient desired a 1-step surgical reconstruction (same patient as in Media Files 19-20).

(Enlarge Image)

Media file 19: A dorsal nasal rotation flap was used to repair this distal defect (same patient as in Media Files 18 and 20).

[ CLOSE WINDOW ]

A dorsal nasal rotation flap was used to repair this distal defect (same patient as in Media Files 18 and 20).

(Enlarge Image)

Media file 20: At 3 months, the flap has provided an aesthetic appearance that exceeds the typical appearance of a graft repair (same patient as in Media Files 18-19).

[ CLOSE WINDOW ]

At 3 months, the flap has provided an aesthetic appearance that exceeds the typical appearance of a graft repair (same patient as in Media Files 18-19).

(Enlarge Image)

Media file 21: A deep surgical wound on the lateral nasal sidewall. Insufficient tissue is available on the proximal nose to harvest a flap that will cover the wound (same patient as in Media Files 22-23).

[ CLOSE WINDOW ]

A deep surgical wound on the lateral nasal sidewall. Insufficient tissue is available on the proximal nose to harvest a flap that will cover the wound (same patient as in Media Files 22-23).

(Enlarge Image)

Media file 22: To adequately replace the volume of tissue that has been surgically removed, an island pedicle flap is used to repair this nasal wound. Note that the flap does not taper until the most lateral ala. Also note the deep flap concavity that minimizes the visibility of postoperative pincushioning (same patient as in Media Files 21 and 23).

[ CLOSE WINDOW ]

To adequately replace the volume of tissue that has been surgically removed, an island pedicle flap is used to repair this nasal wound. Note that the flap does not taper until the most lateral ala. Also note the deep flap concavity that minimizes the visibility of postoperative pincushioning (same patient as in Media Files 21 and 23).

(Enlarge Image)

Media file 23: Final aesthetic result of the island pedicle flap repair. Note the excellent restoration of the nasal contour (same patient as in Media Files 21-22).

[ CLOSE WINDOW ]

Final aesthetic result of the island pedicle flap repair. Note the excellent restoration of the nasal contour (same patient as in Media Files 21-22).

(Enlarge Image)

Media file 24: A nasal tip wound located medially (same patient as in Media Files 25-26).

[ CLOSE WINDOW ]

A nasal tip wound located medially (same patient as in Media Files 25-26).

(Enlarge Image)

Media file 25: A pedicled flap has been used to reach this distant surgical defect. The donor morbidity of this pedicled nasolabial flap was predicted to be lower than the morbidity associated with a paramedian forehead flap. The pedicle will remain intact for approximately 3 weeks (same patient as in Media Files 24 and 26).

[ CLOSE WINDOW ]

A pedicled flap has been used to reach this distant surgical defect. The donor morbidity of this pedicled nasolabial flap was predicted to be lower than the morbidity associated with a paramedian forehead flap. The pedicle will remain intact for approximately 3 weeks (same patient as in Media Files 24 and 26).

(Enlarge Image)

Media file 26: Final surgical result after separation of the flap. Note the effective restoration of the nasal tip and the inapparent donor scar in the area of the medial cheek (same patient as in Media Files 24-25).

[ CLOSE WINDOW ]

Final surgical result after separation of the flap. Note the effective restoration of the nasal tip and the inapparent donor scar in the area of the medial cheek (same patient as in Media Files 24-25).

(Enlarge Image)

Media file 27: A large surgical wound of the nasal tip and supratip areas following Mohs surgery for a recurrent basal cell carcinoma (same patient as in Media Files 28-29).

[ CLOSE WINDOW ]

A large surgical wound of the nasal tip and supratip areas following Mohs surgery for a recurrent basal cell carcinoma (same patient as in Media Files 28-29).

(Enlarge Image)

Media file 28: The defect has been enlarged to match the nasal aesthetic subunits, and the wound has been covered with a paramedian forehead flap. The pallor of the flap is merely a reflection of the use of local anesthetic with epinephrine (same patient as in Media Files 27 and 29).

[ CLOSE WINDOW ]

The defect has been enlarged to match the nasal aesthetic subunits, and the wound has been covered with a paramedian forehead flap. The pallor of the flap is merely a reflection of the use of local anesthetic with epinephrine (same patient as in Media Files 27 and 29).

(Enlarge Image)

Media file 29: Two months after separation and insertion of the forehead flap (same patient as in Media Files 27-28).

[ CLOSE WINDOW ]

Two months after separation and insertion of the forehead flap (same patient as in Media Files 27-28).

(Enlarge Image)

Media file 30: A Mohs surgical defect of the medial cheek and nose.

[ CLOSE WINDOW ]

A Mohs surgical defect of the medial cheek and nose.

(Enlarge Image)

Media file 31: The wound has been repaired with medial advancement of the cheek and a full-thickness skin graft.

[ CLOSE WINDOW ]

The wound has been repaired with medial advancement of the cheek and a full-thickness skin graft.

(Enlarge Image)

Media file 32: The surgical result at 4 months.

[ CLOSE WINDOW ]

The surgical result at 4 months.

(Enlarge Image)

Media file 33: A recurrent basal cell carcinoma of the left ala.

[ CLOSE WINDOW ]

A recurrent basal cell carcinoma of the left ala.

(Enlarge Image)

Media file 34: A full-thickness alar defect has been produced upon tumor removal.

[ CLOSE WINDOW ]

A full-thickness alar defect has been produced upon tumor removal.

(Enlarge Image)

Media file 35: A turn-over nasolabial flap, where the medial cheek skin serves as both nasal lining and external nasal coverage, is used to repair this wound in a single operative procedure. Note the temporary elevation of the ipsilateral upper lip.

[ CLOSE WINDOW ]

A turn-over nasolabial flap, where the medial cheek skin serves as both nasal lining and external nasal coverage, is used to repair this wound in a single operative procedure. Note the temporary elevation of the ipsilateral upper lip.

(Enlarge Image)

Media file 36: The 6-month lateral view of the well-healed flap.

[ CLOSE WINDOW ]

The 6-month lateral view of the well-healed flap.

(Enlarge Image)

Media file 37: Oblique view of the reconstructed left ala.

[ CLOSE WINDOW ]

Oblique view of the reconstructed left ala.

(Enlarge Image)

Media file 38: A large nasal tip defect with the underlying cartilage intact.

[ CLOSE WINDOW ]

A large nasal tip defect with the underlying cartilage intact.

(Enlarge Image)

Media file 39: The wound has been extended to meet the aesthetic sub-unit boundaries, and the larger wound has been repaired with a paramedian forehead flap.

[ CLOSE WINDOW ]

The wound has been extended to meet the aesthetic sub-unit boundaries, and the larger wound has been repaired with a paramedian forehead flap.

(Enlarge Image)

Media file 40: Post-operative view at week 16. Note the well-hidden incision lines at the junctions of aesthetic units.

[ CLOSE WINDOW ]

Post-operative view at week 16. Note the well-hidden incision lines at the junctions of aesthetic units.

(Enlarge Image)

Media file 41: A shallow wound along the nasal sidewall.

[ CLOSE WINDOW ]

A shallow wound along the nasal sidewall.

(Enlarge Image)

Media file 42: An advancement flap from the medial cheek has been used to cover the wound.

[ CLOSE WINDOW ]

An advancement flap from the medial cheek has been used to cover the wound.

(Enlarge Image)

Media file 43: A well-healed flap at 4 months.

[ CLOSE WINDOW ]

A well-healed flap at 4 months.

(Enlarge Image)

Media file 44: An off-center wound near the nasal supratip.

[ CLOSE WINDOW ]

An off-center wound near the nasal supratip.

(Enlarge Image)

Media file 45: A Burow flap has been used to place the inferior dog-ear excision exactly in the nasal midline.

[ CLOSE WINDOW ]

A Burow flap has been used to place the inferior dog-ear excision exactly in the nasal midline.

(Enlarge Image)

Media file 46: Because the alar symmetry has been retained, the aesthetic results are pleasing.

[ CLOSE WINDOW ]

Because the alar symmetry has been retained, the aesthetic results are pleasing.

(Enlarge Image)

Media file 47: A multiply recurrent basal cell carcinoma with severe scarring and alar retraction.

[ CLOSE WINDOW ]

A multiply recurrent basal cell carcinoma with severe scarring and alar retraction.

(Enlarge Image)

Media file 48: A complex nasal wound with missing skin, cartilage, and mucosal lining was produced upon tumor removal.

[ CLOSE WINDOW ]

A complex nasal wound with missing skin, cartilage, and mucosal lining was produced upon tumor removal.

(Enlarge Image)

Media file 49: A bipedicled flap was used to restore the missing nasal lining, a cartilage graft from the concha was used to restore the stiffness of the ala, and an overlying paramedian forehead flap was used for skin coverage.

[ CLOSE WINDOW ]

A bipedicled flap was used to restore the missing nasal lining, a cartilage graft from the concha was used to restore the stiffness of the ala, and an overlying paramedian forehead flap was used for skin coverage.

(Enlarge Image)

Media file 50: An aesthetically appropriate result for a very complicated nasal wound.

[ CLOSE WINDOW ]

An aesthetically appropriate result for a very complicated nasal wound.

(Enlarge Image)

Media file 51: The photograph represents a pedicled nasolabial flap because the flap originates from the nasolabial (or melolabial) fold and a thick muscular pedicle remains attached.

[ CLOSE WINDOW ]

The photograph represents a pedicled nasolabial flap because the flap originates from the nasolabial (or melolabial) fold and a thick muscular pedicle remains attached.

(Enlarge Image)

Media file 52: The photograph depicts a traditional nasolabial transposition flap.

[ CLOSE WINDOW ]

The photograph depicts a traditional nasolabial transposition flap.

More on Nasal Reconstruction

Overview: Nasal Reconstruction

Workup: Nasal Reconstruction

Treatment: Nasal Reconstruction

Multimedia: Nasal Reconstruction

References

« Previous Page

[ CLOSE WINDOW ]

References

Cook JL, Perone JB. A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery. Arch Dermatol. Feb 2003;139(2):143-52. [Medline].
Rowe DE, Carroll RJ, Day CL Jr. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. Apr 1989;15(4):424-31. [Medline].
Rohrer TE, Dzubow LM. Conchal bowl skin grafting in nasal tip reconstruction: clinical and histologic evaluation. J Am Acad Dermatol. Sep 1995;33(3):476-81. [Medline].
Cook JL. A review of the bilobed flap's design with particular emphasis on the minimization of alar displacement. Dermatol Surg. Apr 2000;26(4):354-62. [Medline].
Cook JL. Reconstructive utility of the bilobed flap: lessons from flap successes and failures. Dermatol Surg. Aug 2005;31(8 Pt 2):1024-33. [Medline].
Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. Jul 1989;125(7):957-9. [Medline].
Zitelli JA, Moy RL. Buried vertical mattress suture. J Dermatol Surg Oncol. Jan 1989;15(1):17-9. [Medline].
Fosko SW, Dzubow LM. Nasal reconstruction with the cheek island pedicle flap. J Am Acad Dermatol. Oct 1996;35(4):580-7. [Medline].
Hairston BR, Nguyen TH. Innovations in the island pedicle flap for cutaneous facial reconstruction. Dermatol Surg. Apr 2003;29(4):378-85. [Medline].
Menick FJ. Aesthetic refinements in use of forehead for nasal reconstruction: the paramedian forehead flap. Clin Plast Surg. Oct 1990;17(4):607-22. [Medline].
Menick FJ. A new modified method for nasal lining: the Menick technique for folded lining. J Surg Oncol. Nov 1 2006;94(6):509-14. [Medline].
Burget GC. Aesthetic reconstruction of the tip of the nose. Dermatol Surg. May 1995;21(5):419-29. [Medline].
Burget GC, Menick FJ. Repair of small surface defects. In: Aesthetic Reconstruction of the Nose. St. Louis, Mo: Mosby-Year Book; 1994:117-56.
Cook J, Zitelli JA. Primary closure for midline defects of the nose: a simple approach for reconstruction. J Am Acad Dermatol. Sep 2000;43(3):508-10. [Medline].
Dzubow LM. Flap dynamics. J Dermatol Surg Oncol. Feb 1991;17(2):116-30. [Medline].
Goldberg LH, Alam M. Horizontal advancement flap for symmetric reconstruction of small to medium-sized cutaneous defects of the lateral nasal supratip. J Am Acad Dermatol. Oct 2003;49(4):685-9. [Medline].
Lambert RW, Dzubow LM. A dorsal nasal advancement flap for off-midline defects. J Am Acad Dermatol. Mar 2004;50(3):380-3. [Medline].
Menick FJ. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plast Reconstr Surg. May 2002;109(6):1839-55; discussion 1856-61. [Medline].
Menick FJ. Nasal reconstruction: forehead flap. Plast Reconstr Surg. May 2004;113(6):100E-11E. [Medline].
Nguyen TH. Staged cheek-to-nose and auricular interpolation flaps. Dermatol Surg. Aug 2005;31(8 Pt 2):1034-45. [Medline].
Rowe DE, Carroll RJ, Day CL Jr. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol. Mar 1989;15(3):315-28. [Medline].
Silapunt S, Peterson SR, Alam M, Goldberg LH. Clinical appearance of full-thickness skin grafts of the nose. Dermatol Surg. Feb 2005;31(2):177-83. [Medline].
Spear SL, Kroll SS, Romm S. A new twist to the nasolabial flap for reconstruction of lateral alar defects. Plast Reconstr Surg. Jun 1987;79(6):915-20. [Medline].
Zitelli JA. The nasolabial flap as a single-stage procedure. Arch Dermatol. Nov 1990;126(11):1445-8. [Medline].

[ CLOSE WINDOW ]

Keywords

nasal reconstruction, nasal reconstructive procedures, facial reconstruction, surgical flaps, linear repair, split-thickness skin graft, full-thickness skin graft, Burow graft, random pattern cutaneous flap, axial pattern cutaneous flap, rhombic transposition flap, bilobed transposition flap, dorsal nasal rotation flap, nasolabial transposition flap, island pedicle flap, pedicled nasolabial transposition flap, paramedian forehead flap

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jonathan Cook, MD, Director of Dermatologic Surgery, Professor, Department of Medicine, Division of Dermatology, Duke University School of Medicine
Jonathan Cook, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Medical Editor

Désirée Ratner, MD, Director of Dermatologic Surgery, Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center, New York Presbyterian Hospital
Désirée Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

Search for CME/CE on This Topic »

CLOSE [X]
SPECIALTY SITES Allergy & Clinical Immunology Anesthesiology Cardiology Critical Care Dermatology Diabetes & Endocrinology Emergency Medicine Family Medicine Gastroenterology General Surgery Hematology-Oncology HIV/AIDS Infectious Diseases	Internal Medicine Lab Medicine Nephrology Neurology Ob/Gyn & Women's Health Oncology Ophthalmology Orthopaedics Pathology & Lab Medicine Pediatrics Plastic Surgery & Aesthetic Medicine Psychiatry & Mental Health Public Health & Prevention Pulmonary Medicine	Radiology Rheumatology Surgery Transplantation Urology Women's Health OTHER SITES Business of Medicine Medscape Today Med Students Nurses Pharmacists

eMedicine Specialties > Dermatology > Surgical

Nasal Reconstruction: Multimedia

Multimedia

An apparently small recurrent basal cell carcinoma on the lateral ala (same patient as in Media File 2).

Extensive subclinical tumor extension is identified following excision by using the Mohs micrographic surgical technique (same patient as in Media File 1).

A central nasal defect of approximately 1 cm. Note that the location of the wound is in the nasal midline (same patient as in Media Files 4-5).

Linear closure on the nasal tip. Because the diameter of the defect is small, wound-closure tension (and therefore alar distortion) is minimal (same patient as in Media Files 3 and 5).

Linear closure on the nose 8 weeks postoperatively. Note the acceptable cicatrix and the minimal alar elevation (same patient as in Media Files 3-4).

Complex skin and soft tissue defect on the nasal dorsum and sidewalls (same patient as in Media Files 7-8).

Glabellar and cheek components of the wound have been closed with local tissue advancement. As a result of its shallow nature and location on nonsebaceous skin, the larger nasal portion of the wound has been covered with a full-thickness skin graft (same patient as in Media Files 6 and 8).

The early result (8 wk) of the repair is acceptable. The slight amount of hyperpigmentation of the skin graft will likely resolve without further surgical intervention (same patient as in Media Files 6-7).

A central nasal defect that extended to the perichondrium. The patient was not interested in pedicled flap repair (same patient as in Media Files 10-11).

A Burow graft repair diminished the size of the required graft and harvested suitable tissue from the more proximal nasal dorsum (same patient as in Media Files 9 and 11).

The final aesthetic result is acceptable to the patient. Note the only slight visibility of the graft (same patient as in Media Files 9-10).

A small Mohs defect on the nasal sidewall (same patient as in Media Files 13-14).

A rhombic flap is used to donate more available proximal nasal skin into the surgical defect (same patient as in Media Files 12 and 14).

At 8 weeks, the aesthetic result from the repair is excellent (same patient as in Media Files 12-13).

A surgical defect of approximately 1.5 cm on a sebaceous distal part of the nose (same patient as in Media Files 16-17).

The wound is reconstructed with a bilobed transposition flap. The distal part of the nose is not distorted because the flap is properly designed (same patient as in Media Files 15 and 17).

At 8 weeks after flap repair, the nose has healed nicely without additional intervention (same patient as in Media Files 15-16).

A large surgical wound on the nasal tip. The patient desired a 1-step surgical reconstruction (same patient as in Media Files 19-20).

A dorsal nasal rotation flap was used to repair this distal defect (same patient as in Media Files 18 and 20).

At 3 months, the flap has provided an aesthetic appearance that exceeds the typical appearance of a graft repair (same patient as in Media Files 18-19).

A deep surgical wound on the lateral nasal sidewall. Insufficient tissue is available on the proximal nose to harvest a flap that will cover the wound (same patient as in Media Files 22-23).

Final aesthetic result of the island pedicle flap repair. Note the excellent restoration of the nasal contour (same patient as in Media Files 21-22).

A nasal tip wound located medially (same patient as in Media Files 25-26).

Final surgical result after separation of the flap. Note the effective restoration of the nasal tip and the inapparent donor scar in the area of the medial cheek (same patient as in Media Files 24-25).

A large surgical wound of the nasal tip and supratip areas following Mohs surgery for a recurrent basal cell carcinoma (same patient as in Media Files 28-29).

The defect has been enlarged to match the nasal aesthetic subunits, and the wound has been covered with a paramedian forehead flap. The pallor of the flap is merely a reflection of the use of local anesthetic with epinephrine (same patient as in Media Files 27 and 29).

Two months after separation and insertion of the forehead flap (same patient as in Media Files 27-28).

A Mohs surgical defect of the medial cheek and nose.

The wound has been repaired with medial advancement of the cheek and a full-thickness skin graft.

The surgical result at 4 months.

A recurrent basal cell carcinoma of the left ala.

A full-thickness alar defect has been produced upon tumor removal.

A turn-over nasolabial flap, where the medial cheek skin serves as both nasal lining and external nasal coverage, is used to repair this wound in a single operative procedure. Note the temporary elevation of the ipsilateral upper lip.

The 6-month lateral view of the well-healed flap.

Oblique view of the reconstructed left ala.

A large nasal tip defect with the underlying cartilage intact.

The wound has been extended to meet the aesthetic sub-unit boundaries, and the larger wound has been repaired with a paramedian forehead flap.

Post-operative view at week 16. Note the well-hidden incision lines at the junctions of aesthetic units.

A shallow wound along the nasal sidewall.

An advancement flap from the medial cheek has been used to cover the wound.

A well-healed flap at 4 months.

An off-center wound near the nasal supratip.

A Burow flap has been used to place the inferior dog-ear excision exactly in the nasal midline.

Because the alar symmetry has been retained, the aesthetic results are pleasing.

A multiply recurrent basal cell carcinoma with severe scarring and alar retraction.

A complex nasal wound with missing skin, cartilage, and mucosal lining was produced upon tumor removal.

A bipedicled flap was used to restore the missing nasal lining, a cartilage graft from the concha was used to restore the stiffness of the ala, and an overlying paramedian forehead flap was used for skin coverage.

An aesthetically appropriate result for a very complicated nasal wound.

The photograph represents a pedicled nasolabial flap because the flap originates from the nasolabial (or melolabial) fold and a thick muscular pedicle remains attached.

The photograph depicts a traditional nasolabial transposition flap.

More on Nasal Reconstruction

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor