Expanded Uses of the Dorsal Nasal Flap: Redefining the Nasal Reconstruction Algorithm.

Background: Defects of the nose present complex reconstructive challenges to the plastic surgeon. We present our experience with using the dorsal nasal flap (DNF) to provide a durable reconstruction even in sizable defects that would otherwise be considered necessitating a paramedian forehead flap.

Methods: We conducted a retrospective chart review of patients who underwent reconstruction by DNF following resection of skin cancers on the nose. Six flap-type modifications are described: limited, standard, double, combined, extended, and readvanced.

Results: From 2015 to 2021, a total of 51 patients underwent DNF reconstruction. The most frequently used flap types were the limited or standard configurations. There is a general trend of utilizing increasingly complex flap types to reconstruct larger defect sizes, as depicted in our reconstructive algorithm. There were no flap losses.

Conclusions: Our study expands the indications of the DNF and redefines the nasal reconstruction algorithm. However, our proposition is not absolute in that one must consider tissue pliability and the location of the defect.