The Versatility of Expanded Applications of the Dorsal Nasal Flap in Nasal Reconstruction

Abstract

Background: Aesthetic nasal reconstruction always offers a challenge to the plastic surgeon, especially with large defects of more than 2cm. The modification of the dorsal nasal flap might offer a superior alternative for the forehead flap.Objective: In this study, we aimed to assess the outcomes of the dorsal nasal flap in the reconstruction of large nasal defects beyond the original indications. Patients and Methods:We have prospectively studied 12 patients older than 40 years with skin-only nasal defects occupying the distal 2/3 of the nose, larger than 2cm in size, and/ or located less than 5mm from the alar rim. A modified dorsal nasal flap was done in all the cases. Results:The mean age of patients was 59.33±7.01 years. The mean dimensions of lesions were 25±2.32mm with a mean distance of 2.57±1.62mm from the alar rim. Regarding Aesthetic outcomes, patients and surgeons expressed excellent color match in 91.7% of patients. As for alar retraction, patients and doctors expressed good to excellent results in 83% of patients. Additionally, patients and physicians reported good to excellent nostril shape in 83.3% and 66.6% of patients respectively. Regarding the flap thickness, patients and doctors expressed good to excellent results in 91.6% and 75% of patients respectively. Conclusion:The dorsal nasal flap seems to be more applicable than classically reported. Defects up to 29mm in size and/or defects located 2mm from the alar rim result in acceptable to excellent aesthetic outcomes when the modified dorsal nasal flap applied in this work is used. Our modified dorsal nasal flap resulted in excellent outcomes in 4 cases, accepted outcomes in 5 cases, and unfavorable outcomes in 3 cases.