Survival of Nasal Tip Flap on Only the Columellar Attachment

The nose has a robust blood supply derived from both internal and external carotid arteries. The main blood supply of the nasal tip and skin is derived primarily from the lateral nasal arteries, with a variable contribution from the columellar arteries. We present a patient with cut nose resulting from a homicidal attack in which the lower two-thirds of the nose was severed starting at the bony-cartilaginous junction of the dorsum of the nose down to the tip of the nose. The skin-cartilage flap was attached only to the columella and to the caudalmost 3 mm of the left ala nasi. The detached skin-cartilage flap was replaced and sutured anatomically, and the flap completely survived in spite of cutting of both lateral and dorsal nasal arteries.