Reconstruction of Large Nasal Defects without Interpolated Flaps

In this presentation, Dr. Julia Bolts discusses techniques for reconstructing large nasal defects without the use of interpolated flaps. She introduces the crescentic advancement flap, originally designed for the lateral nasal sidewall, and describes its application to larger defects on the nose, providing case studies to illustrate successful outcomes. Key considerations include proper flap design, the importance of the piriform ligament for maintaining structure, and the technique of allowing targeted secondary intention healing. Dr. Bolts then shifts focus to multilope flaps, such as the bilobe and trilobe, emphasizing their suitability for larger defects and the significance of flap design based on the size of the defect. She explains crucial design principles, including the alignment of the nasolabial folds and preservation of alar symmetry, sharing multiple successful patient cases, including those with significant defects. Lastly, she mentions the rotated island pedicle flap, a one-stage option for reconstructing lateral full-thickness nasal defects, highlighting its effectiveness. Overall, Dr. Bolts presents a comprehensive overview of innovative techniques and considerations for nasal reconstruction, showcasing their practical applications through case examples.