Three-dimensional modeling and comparison of nasal flap designs

Few studies exist that compare local flap repair designs either mathematically or clinically. Previous mathematical studies use a two-dimensional modeling approach, which is not suited to complex structures like the nose. To quantitatively analyze and compare flap designs for nasal repair using three-dimensional, photographic models. via a three-dimensional imaging system (Vectra M3, Canfield Scientific, Parsippany, NJ, USA), images were captured of actual post-Mohs nasal defects on 12 consecutive patients. Transposition, rotation, and advancement flap designs were designed and assessed based on tissue efficiency (E_t = SA_wound/(SA_wound + SA_trimmed) × 100), suture efficiency (E_s = SA_wound/Length_sutured × 100), total area undermined, combined 1° and 2° flap motion efficiency (E_fm = SA_wound/(SA_undermined - (SA_wound + SA_trimmed)) × 100), incision efficiency (E_i = SA_wound/length_incision × 100), and undermining efficiency (E_u = SA_wound/SA_undermined × 100). Rotation flap designs are the most tissue efficient (p < 0.001). Transposition designs are the least suture efficient (p = 0.012) and require less undermining than the corresponding rotation flaps (although not statistically significant). Advancement flaps have the highest flap motion efficiency (p = 0.027). Incision and undermining efficiency is equivalent between all three designs (p = 0.308 and p = 0.158, respectively). While statistically significant differences exist between the flaps studied, the clinical significance is unknown. Consequently, the choice in repair design should be made based on its ability to attain a functionally and aesthetically successful reconstruction.