A Combination Flap for Nasal Defect Reconstruction

Nasal reconstruction is a common plastic surgery procedure following cancer resection. Whereas most small and medium defects are managed using standard local flaps, reconstructive options available for large defects of the nose such as a heminasal defect are very few. Most of the large defects are usually managed using a forehead flap, which involves at least 2 stages or using free tissue transfer. The author describes a combination flap that can be used for reconstruction of heminasal defects as well as lateral wall defects.

A cheek advancement flap with the nasolabial flap incorporated in it as a combined flap was used for reconstructing heminasal defects and lateral wall defects in 11 patients. Four of the cases were following Mohs surgery for skin cancer, and others, primary reconstruction following wide excision of skin cancer. Five of the cases required cartilage support with or without lining, and others were skin-only defects. All were done as single-stage procedures.

The cases were followed up over a period ranging from 6 to 18 months. There were no immediate complications in any of the cases, and all flaps survived completely. Assessment was done in terms of function, appearance, requirement for further procedures, and patient satisfaction. Outcome was deemed excellent in 8 patients. One patient had deviation of the nasal septum, and 2 patients had cheek scars in an unfavorable direction.

The combination flap is a simple, single-stage procedure useful for reconstruction of heminasal and lateral wall defects. This technique is easily reproducible and provides consistently good results.