Reconstruction of the external nose with local flaps

The skin of the external nose can be damaged by the removal of tumours, in particular skin cancer, or by accidents. Small defects can often be closed directly or covered with a skin graft. For larger or awkwardly located wounds, local flaps are used: healthy skin from the immediate surroundings is moved into the defect with its own blood supply, so that colour and texture match the nose well. Which type of flap is chosen depends on the size of the defect, the region of the nose involved and the mobility of the skin.

Local flaps

For smaller defects of the nasal tip and dorsum, bilobed or rotation flaps are frequently used, swung into the wound from around the nose. Defects on the sidewall can be covered well with flaps from the cheek or the nasolabial fold. For larger defects involving several layers, the forehead flap is available: a pedicled flap from the forehead is led over a narrow bridge to the nose and fitted in there; it is supplied by the supratrochlear artery and later separated from its pedicle in a second session.

Procedure

Before the operation, the defect and the planned flap shape are defined using photographs, drawings and, where necessary, imaging. The operation itself is performed under local or general anaesthesia depending on its extent. The flap is incised, swung into the defect and sutured with fine stitches; the donor site is closed directly.

After the procedure

After the operation, wound care, scar care and follow-up appointments are arranged. With a forehead flap, the pedicle is separated and the nose refined in a second session after a few weeks. In this way even more extensive defects can be provided with tissue that preserves the appearance and function of the nose.

Who is a candidate

Local flaps of the external nose are considered above all after the removal of skin tumours or after accidents, when a defect cannot be closed directly. Whether a local flap is suitable in an individual case, and which technique is chosen, is decided by the medical team during treatment planning.