Closure of nasal defects after tumor excision with local flaps

There is a myriad of proposals for nasal defect closure. One of the older concepts, the so-called topographical concept, adheres to the nasal subunit principle without taking into consideration textural details of the nasal skin such as thickness and mobility. In a newer concept, a morphological concept, the texture of the nasal skin is a basic consideration for defect closure. The morphological or textural concept demands defect closures only with local flaps of nearly identical texture located within the "unit" nose. In order to find out how the morphological concept influenced our operative design, we carried out a retrospective study from 1988 to 1995 checking the defect closure of all basal cell carcinoma on the nose. Of 598 basal cell carcinoma operated in the face, 141 were located on the nose. During the first years, free skin grafts and regional flaps dominated our operative design, in recent years the use of local flaps according to the criteria of the morphological concept increased significantly, leading not only to functional but also to more aesthetic results.