Reconstruction of nasal defects larger than 1.5 centimeters in diameter

To review the repair of larger nasal defects (> 1.5 cm in diameter) and the vascular supply to the forehead flap.

Retrospective chart review (1994-1999) and cadaver analysis of forehead flap vasculature.

Chart review was made of patients with cutaneous nasal defects greater than 1.5 cm in diameter. An intravascular silicone cast was used to detail the arterial supply to forehead flaps focusing on contribution from the supratrochlear and angular vessels.

In 127 patients with nasal defects, 76 defects were greater than 1.5 cm in diameter and were repaired with a midline forehead flap (44 [58%]), paramedian forehead flap (3 [4%]), single-stage midline forehead flap (8 [11%]), interpolated melolabial flap (5 [7%]), local nasal flap (7 [9%]), or skin graft (9 [12%]). All original defects were modified to some degree with an aggressive application of the nasal esthetic subunit principle. Forty-three patients (57%) had cartilage grafts, 18 (24%) had a full-thickness defect requiring repair of the internal lining, and 11 (14%) had some degree of complication, although no patient had full-thickness necrosis of a flap or required a second flap. Analysis of the vascular pedicle to the midline and paramedian forehead flaps demonstrated significant contributions from the angular artery. Skin paddles from a midline and paramedian forehead flap had similar vascular arcades.

Nasal reconstruction has reached a standard of consistent esthetic results with restoration of nasal function. The midline forehead flap is dependable and robust and leaves a donor site scar consistent with the principle of esthetic units.