Nasal Reconstruction: Thinking Outside of the Box

In this presentation, Adam Sutton, director of Mohs at the University of Nebraska, discusses innovative approaches to nasal reconstruction, particularly focusing on distal nasal defects that pose significant surgical challenges. He stresses the importance of understanding patient goals for reconstruction while considering cosmetic and functional outcomes. Sutton highlights the evaluation of surgical risks, including patient comorbidities and anatomical nuances. He provides case studies detailing reconstructive options for challenging nasal defects, such as utilizing bilobe and trilobe flaps, which allow for versatile tissue recruitment from non-adjacent areas. Sutton emphasizes the advantages and limitations of these flap designs, focusing on aesthetic considerations and minimizing complications like pin cushioning and alar deformities. He presents the paranasal interpolation flap as a viable alternative for lateral alar defects, underscoring its efficacy for small, deep defects while discussing outcomes and patient satisfaction. Sutton concludes by reiterating the necessity to carefully consider both the methodology and the purpose behind reconstruction efforts, aiming for optimal results for patients with complex nasal challenges.