Reconstructive perspectives of cutaneous defects involving the nasal tip: a retrospective review.

Objectives: To create an algorithm that derives our preferred reconstruction technique for cutaneous defects involving the nasal tip and to review the management and outcomes of patients with nasal tip cutaneous defects after their initial reconstruction.

Methods: A retrospective review of patients undergoing repair of cutaneous defects involving the nasal tip between January 2006 and January 2009. After data compilation, a defect-based algorithm deriving our repair technique was created.

Results: Seventy-two patients were identified: 57% underwent full-thickness skin graft repair (n = 41), 19% underwent forehead flap repair (n = 14), and 17% underwent bilobe flap repair (n = 12). The remaining 7% underwent repair using nasal cutaneous flaps harvested adjacent to the defect (n = 5). Nasal tip defect involvement of an adjacent nasal aesthetic unit was the most critical factor in selecting a reconstruction technique. Further categorization by the presence of nasal ala involvement, cartilage exposure, and defect surface area allowed reliable prediction of our reconstruction technique. Dermabrasion was routinely performed early in the postoperative course (25% [18 of 72 patients]). Corticosteroid injection was commonly used for those undergoing forehead flap (71% [10 of 14 patients]) and bilobe flap (50% [6 of 12 patients]) repair. Aesthetic revision surgery was infrequently required (15% [11 of 72 patients]). All aesthetic outcomes were good or satisfactory.

Conclusion: The included algorithm offers a systematic approach for managing cutaneous defects involving the nasal tip and derives our preferred technique with high reliability.