Current Paradigms of Reconstruction of the Nose Following Cancer Extirpation

Session Description

The nose is the most common site for skin cancers.  Nasal reconstruction has many nuances including aesthetic priorities and restoring function.  There are algorithms for small and large cutaneous defects and special considerations when the defect is full-thickness.  Local flaps such as the East-West flap are versatile for many smaller defects.  Oftentimes a combination of a local flap and FTSG from a standing cone is an excellent combination for slightly larger defects.  The lower lateral third of the nose, the nasal sidewall / valve, must have a reconstruction that includes structural reinforcement with cartilage grafts.  Notching, collapse, and nasal obstruction are common sequelae when this is not performed.  Restoring lining is complex but essential for full-thickness defects.  When the lining deficiency is large, a safe paradigm is using a FTSG under a forehead flap and perform the reconstruction in three stages.