A New Flap for Nasal Tip Reconstruction

Aesthetic reconstruction of tumor defects of the nasal tip and supratip areas remains a challenge. Because of our dissatisfaction with the current reconstructive options, we have developed a modification of the nasalis flap based on the angular artery for the management of nasal tip defects. This is an axial flap-pattern that rotates toward the midline and nasal tip, leaving donor scars in the nasojugal and alar creases. A second rotation flap from the alar groove fills the donor defect in the nasojugal region to minimize scarring. We have utilized this flap 19 times in 18 consecutive patients with nasal tip and supratip tumor defects with follow-up ranging from 10 to 72 months. Donor scars are well concealed and nasal contour is minimally altered. Color and texture matches are excellent, and the pincushion deformity has been eliminated. On the basis of these results, we believe the modified nasalis flap is ideally suited for nasal tip reconstruction.