Reconstruction of nasal defects 1.5 cm or smaller.

OBJECTIVES To review the repair of smaller nasal defects (≤1.5 cm) and their associated complications, elaborating on nasal obstruction and techniques to avoid it, and to determine outcomes with functional cartilage grafting. METHODS The medical records of patients requiring nasal reconstruction for Mohs defects 1.5 cm or smaller were reviewed. Variables analyzed included defect location, defect size, use of cartilage, flap design, smoking status, and postoperative complications (nasal obstruction and flap/graft necrosis). RESULTS A total of 208 patients with 213 nasal defects 1.5 cm or smaller were identified. The most common location was the alar subunit, followed by the tip, dorsum, and sidewall. Ninety-eight of the defects (46.0%) used cartilage grafts for reconstruction. Seventy-three of 84 alar defects (86.9%) were reconstructed with cartilage as a composite or batten graft. The sidewall and dorsum were the least likely to require cartilage grafting: 1 of 15 (6.7%) and 0 of 21, respectively. Ten patients (4.8%) had a postoperative complication: 6 of 19 smokers (31.6%) and 4 of 189 nonsmokers (2.1%). Overall, nasal obstruction was an infrequent complication (1.4%). CONCLUSIONS Regardless of defect size, defect location, and flap design, smokers were at higher risk for postoperative complications. Subtle modifications in the classic flap design and liberal use of cartilage grafting reduce the risk of postoperative nasal obstruction.