Inferiorly-hinged transnasal advancement flap with back-cut for medial canthal reconstruction: A case series

The authors present variations of the inferiorly-hinged transnasal advancement flap, augmented with an inferior back-cut, as a versatile option for medial canthal defect reconstruction. A retrospective case series of seven patients with medial canthal basal cell carcinoma, all of whom underwent frozen section-controlled excision followed by immediate reconstruction using this flap technique. Surgical modifications included tailored flap sizing and use of back-cuts to enhance flap mobility. Outcomes included Strasser grading, using post-operative photographs, and complications. All defects were reconstructed successfully, with scars concealed and no major complications. Five tumours were T1a and two were staged T2b, producing defects ranging from 12 × 12 mm to 30 × 18 mm in diameter. These cases demonstrate the flap's suitability for moderate to large defects that are not amenable to simple techniques such as primary closure. Strasser grading across six patients showed good aesthetic outcomes (scores 0-2) with no cases rated 'obvious' or 'deforming'. This report highlights the versatility of the inferiorly-hinged transnasal advancement flap as a first-line option for medial canthal defects. It provides excellent cosmesis particularly for moderate to large defects in patients with adequate nasal bridge laxity, a natural skin crease inferior to the glabella, and those who wear spectacles.