Nose is a masterpiece because of its anatomy, physiology, and aesthetic appearance. It is located at the midface and involves three layers structurally: (1) outer covering (skin, subcutaneous tissue, and muscles), (2) framework (nasal bones, quadrangular cartilage, upper and lower lateral cartilages), and (3) inner lining (mucoperichondrium/periosteum and skin of the nasal vestibule). Moreover, it is aesthetically subdivided into different subunits according to its natural creases and/or boundaries: (1) dorsum, (2) sidewalls, (3) alar regions, (4) tip, and (5) columella. The outer covering is distinctive in each subunit and mainly grouped into three zones according to the degree of subcutaneous fat, skin thickness, sebaceous content, and mobility: (1) zone 1 has a non-sebaceous, thin, and mobile skin and includes upper dorsum and sidewalls; (2) zone 2 has a sebaceous, thick, and semimobile skin and includes supratip, tip, and alar lobules; and (3) zone 3 has a non-sebaceous, thin, nonmobile skin and includes soft tissue triangles, infratip lobules, and columella. Aesthetic improvement is of utmost important for nasal reconstruction. Therefore, reconstruction with a local flap is frequently preferred as a first-line surgical modality particularly for small to moderate nasal defects. Local nasal flaps may provide the ideal color and texture match using a healthy outer covering of nose. The most commonly used local nasal flaps are as follows: (1) bilobed flap, (2) rhombic flap, (3) dorsal advancement flap (Rintala flap), (4) dorsal nasal flap (Rieger flap), and (5) transposition flaps. This chapter describes the principles of nasal reconstruction with local nasal flaps and aims to guide surgeons in planning and decision-making with local nasal flaps in nasal reconstruction.
KeywordsLocal nasal flaps Bilobed flap Rhombic flap Dorsal advancement flap (Rintala flap) Dorsal nasal flap (Rieger flap) Transposition flaps
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