Single-Stage Reconstruction of Larger Nasal Defects Without Interpolated Flaps

Conclusions

• Single-stage local flap techniques can successfully reconstruct many larger central facial and nasal defects that might otherwise be treated with multistage interpolated flaps.
• For crescentic advancement flaps, the defect width should be balanced against anticipated secondary movement, with careful attention to tension vectors and alar support to avoid alar lift or notching.
• Pexing the flap to the pyriform ligament can reduce bridging and tenting and improve the stability of nasal sidewall and alar reconstructions.
• Targeted second-intention healing in the alar groove can be beneficial and should not be avoided when it helps preserve natural contour.
• Patient skin laxity and tissue character strongly influence whether a given nasal defect can be closed with a local flap alone or requires additional techniques.
• Nasolabial fold symmetry matters cosmetically, and neglecting it can create a noticeable penalty even when the defect itself is closed well.
• Bilobed and trilobed flaps can be expanded beyond traditional small-defect indications and can provide excellent outcomes for intermediate and even larger nasal tip defects.
• Choosing between bilobed and trilobed designs depends on defect location, with more distal defects favoring trilobed solutions and more proximal tip defects often suitable for bilobed repair.
• Standing cone geometry and lobe angles are critical determinants of rotation, alar distortion, and final contour in multilobed flap reconstruction.
• Multilobed flaps can sometimes be extended to unusually complex or multilaminar defects and may avert the need for more complex staged reconstruction.
• The spear flap is a useful option for devastating full-thickness alar defects because it can reconstruct the nostril rim by folding and laminating nasolabial tissue rather than detaching an interpolated flap.
• Composite grafts are best reserved for small alar rim defects because they are highly metabolically demanding and have limited size tolerance.
• Composite graft success depends heavily on meticulous technique and postoperative care, including secure internal fixation and close wound management.
• Overall, the presentation argues that thoughtful design and technique selection allow surgeons to ‘get out of trouble’ with single-stage reconstruction in many challenging nasal defects.