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The Rintala Advanced Modification (RAM) Flap: A Novel Technique for Off-Centre Nasal Reconstruction.

Ramy Awadalla^1,2, Derek Davies²

¹School of Rural Medicine, Charles Sturt University, Orange, New South Wales, Australia.

The Australasian Journal of Dermatology

|June 26, 2026

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The Rintala Advanced Modification (RAM) flap improves aesthetic outcomes for nasal reconstruction. This novel technique reduces forehead scarring and avoids glabellar deformities, offering a better alternative for patients.

Area of Science:

Plastic Surgery
Dermatologic Surgery
Reconstructive Surgery

Background:

The traditional Rintala flap for nasal reconstruction can result in noticeable forehead scarring and glabellar deformities.
Existing reconstructive techniques may not fully address aesthetic concerns in the glabellar region.
Minimizing visible scarring and achieving natural-looking results are key goals in nasal reconstruction.

Purpose of the Study:

To introduce and evaluate the Rintala Advanced Modification (RAM) flap as a novel technique for nasal reconstruction.
To assess the aesthetic outcomes and complication rates associated with the RAM flap.
To compare the RAM flap's results against the limitations of the traditional Rintala flap.

Main Methods:

Description of the Rintala Advanced Modification (RAM) flap technique, including its placement below the eyebrow line.

Keywords:

Mohs surgery basal cell carcinoma rhinoplasty squamous cell carcinoma surgical flaps

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Utilization of asymmetric Burow's triangles to manage off-centre nasal defects.

Application of the RAM flap in a cohort of 20 patients undergoing reconstruction for nasal basal cell and squamous cell carcinomas.

Main Results:

The RAM flap demonstrated superior aesthetic outcomes in the studied patient group.
No instances of glabellar complications were reported following reconstruction with the RAM flap.
The technique successfully avoided flap tip necrosis, indicating its reliability.

Conclusions:

The Rintala Advanced Modification (RAM) flap offers a significant improvement over the traditional Rintala flap for nasal reconstruction.
The RAM flap effectively minimizes forehead scarring and prevents glabellar deformities, enhancing patient aesthetics.
This modified technique provides a safe and effective option for reconstructing nasal defects, particularly those resulting from skin cancer excision.