An absolute vascular milieu for primary bone graft in aesthetic nasal reconstruction.

Restoration of a composite nasal defect with an aesthetically acceptable vascularized full-thickness soft tissue cover and a primary bone graft in a surgically unscarred area at the same stage requires that the flap have a complete formal inset from all the sides, for enhancement of the milieu interior. This article addresses such a situation, which required the use of a cantilever bone graft simultaneously with an interpolated midline forehead flap based on the supratrochlear vessel and transferred on a deepithelialized bridge segment, which allowed an absolute inset from all the sides. The eventual aesthetic outcome was satisfactory after a secondary surgery for nasal tip correction using conchal cartilage graft for tip framework. The procedure has allowed placement of the bone graft in an unscarred bed, with a complete inset of the vascularized full-thickness soft tissue cover. This provided the graft with the ideal vascular milieu for survival and consolidation and achieved an aesthetically acceptable soft tissue reconstruction of the nose with minimal donor-site morbidity. It obviated the need for the staged procedures and provided a secure vascular milieu for the primary bone graft.