Reconstructive Options for Complex Nasal, Temple, and Lip Defects

Conclusions

• Small mucosal alar defects can often be reconstructed successfully with simpler turnover or hinge flap techniques, and preserving the caudal skin margin improves options and outcomes.
• Mucosal and skin nasal defects have multiple valid repair pathways, but larger or vertically extensive defects become harder to close primarily and may require more robust flap-based reconstruction.
• Hinge turnovers, nasalis-based flaps, and nasolabial transposition flaps can provide durable nasal reconstruction when executed with attention to thickness, undermining, and key anchoring sutures that restore natural shadowing and avoid tethering.
• For deep temple defects with high-risk cutaneous squamous cell carcinoma, reconstruction should prioritize rapid, reliable closure that permits timely adjuvant radiation rather than the most elaborate cosmetic solution.
• Axial or tunneled forehead/superficial temporal artery-based flaps are particularly useful for deep temple or scalp defects with exposed bone because they are robust enough to survive radiation and support timely oncologic treatment.
• Upper lip reconstruction depends heavily on defect size and preservation of the commissure, with primary closure or wedge repair appropriate for some cases, but larger central defects often benefiting from lip switch or reverse Karapandzic-style flaps.
• When reconstructing the upper lip, preserving the midline, cupid’s bow, and vermilion proportions is critical because simple closure can distort lip aesthetics even when the defect seems technically closable.
• Lip switch flaps can preserve function and contour well in selected large upper lip defects, but they require careful postoperative counseling because temporary oral inconvenience, sensory recovery delay, and pincushioning are expected.
• Across all three cases, the main theme is that reconstructive choice should be individualized to defect anatomy, oncologic urgency, and patient priorities, with a premium on reproducible techniques that restore function while minimizing delay to further treatment.