Triple-flap technique for reconstruction of large nasal defects.

OBJECTIVE To determine the usefulness of a triple-flap technique for repair of large zone 2 Mohs defects of the nose. METHODS The triple-flap technique was performed on 10 fresh adult cadaver heads that had been injected intravascularly with blue dye. Two distances were measured and recorded: (1) the distance from the most lateral portion of the alar crease to the transverse facial artery; and (2) the distance from the dorsal nasal artery to the medial canthi. Data were also collected on patient age and sex and on the size of the Mohs defect in a series of 10 patients. RESULTS The cadaver study showed that the dorsal nasal artery was located a mean distance of 7.4 mm superior to the medial canthal tendon and that the transverse facial artery was located a mean distance of 19.2 mm lateral to the alar crease. In our series of 10 patients (2 of whom are described herein), zone 2 defects (including full-thickness unilateral alar defects) as large as 3.5 x 5.0 cm were reconstructed in 1 stage using local anesthesia. No flap loss resulted. CONCLUSIONS Cadaver dissection enabled us to identify the blood supply of the dorsal nasal flap in relation to the medial canthal tendon and the blood supply to the superior melolabial flap in relation to the alar crease. For a select group of patients with large zone 2 Mohs defects of the nose, the use of the triple-flap technique to repair the defect is a viable alternative to the use of a forehead flap technique.