Local Nasal Flaps

  • Gökçe Tanyeri Toker
  • Görkem Eskiizmir
  • Shan R. Baker


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.


Local nasal flaps Bilobed flap Rhombic flap Dorsal advancement flap (Rintala flap) Dorsal nasal flap (Rieger flap) Transposition flaps 


  1. 1.
    Baker SR. Local cutaneous flaps. Otolaryngol Clin N Am. 1994;27:139–59.Google Scholar
  2. 2.
    Weber SM, Baker SR. Management of cutaneous nasal defects. Facial Plast Surg Clin North Am. 2009;17:395–417.CrossRefGoogle Scholar
  3. 3.
    Steiger JD. Bilobed flaps in nasal reconstruction. Facial Plast Surg Clin North Am. 2011;19:107–11.CrossRefGoogle Scholar
  4. 4.
    Baker SR. Bilobe flaps. In: Baker SR, editor. Local flaps in facial reconstruction. Philadelphia: Mosby; 2007. p. 189–211.Google Scholar
  5. 5.
    Webster RC, Davidson TM, Smith RC. The thirty degree transposition flap. Laryngoscope. 1978;88:85–94.CrossRefGoogle Scholar
  6. 6.
    Yildar M, Cavdar F, Yildiz MK. The evaluation of a modified Dufourmentel flap after S-type excision for pilonidal sinus disease. ScientificWorldJournal. 2013, 459147Google Scholar
  7. 7.
    Lohuis PJ, Godefroy WP, Baker SR, Tasman AJ. Transposition flaps in nasal reconstruction. Facial Plast Surg Clin North Am. 2011;19:85–106.CrossRefGoogle Scholar
  8. 8.
    Jackson I. Nose reconstruction. In: Jackson I, editor. Local flaps in head and neck reconstruction. St.Louis, Missouri: QMP Inc.; 2007. p. 101–241.Google Scholar
  9. 9.
    Rintala AE, Asko-Seljavaara S. Reconstruction of mid-line skin defects of the nose. Scand J Plast Reconstr Surg. 1969;3:105–8.CrossRefGoogle Scholar
  10. 10.
    Chiu LD, Hybarger CP, Todes-Taylor N. The Rintala flap revisited. Plast Reconstr Surg. 1994;94:801–7.CrossRefGoogle Scholar
  11. 11.
    Ebrahimi A, Nejadsarvari N, Koushki ES. Application of modified Rintala flap in nasal tip reconstruction. Am J Otolaryngol. 2012;33:685–8.CrossRefGoogle Scholar
  12. 12.
    Blandini D, Tremolada C, Beretta M, Mascetti M. Use of a versatile axial dorsonasal musculocutaneous flap in repair of the nasal lobule. Plast Reconstr Surg. 1996;98:260–8.CrossRefGoogle Scholar
  13. 13.
    Motamedi KK, Amin SH, DeJoseph LM, Silver WE. Aesthetic modification to the rintala flap: a case series. Aesthet Plast Surg. 2014;38:395–8.CrossRefGoogle Scholar
  14. 14.
    Dzubow LM. Nasal dorsal flaps. In: Baker SR, Swanson NA, editors. Local flaps in facial reconstruction. St Louis, MO: Mosby; 1995. Chapter 14. p. 225–46.Google Scholar
  15. 15.
    Rieger RA. A local flap for repair of the nasal tip. Plast Reconstr Surg. 1967;40:147–9.CrossRefGoogle Scholar
  16. 16.
    Marchac D, Toth B. The axial frontonasal flap revisited. Plast Reconstr Surg. 1985;76:686–94.CrossRefGoogle Scholar
  17. 17.
    Rohrich RJ, Muzaffar AR, Adams WP Jr, Hollier LH. The aesthetic unit dorsal nasal flap: rationale for avoiding a glabellar incision. Plast Reconstr Surg. 1999;104:1289–94.CrossRefGoogle Scholar
  18. 18.
    Johnson TM, Swanson NA, Baker SR, et al. The Rieger flap for nasal reconstruction. Arch Otolaryngol Head Neck Surg. 1995;121:634–7.CrossRefGoogle Scholar
  19. 19.
    Walike JW, Larrabee WF Jr. The “note flap”. Arch Otolaryngol. 1985;111:430–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Gökçe Tanyeri Toker
    • 1
  • Görkem Eskiizmir
    • 2
  • Shan R. Baker
    • 3
  1. 1.Department of Otolaryngology-Head and Neck Surgery, Izmir Katip Celebi UniversityAtaturk Training and Research HospitalİzmirTurkey
  2. 2.Department of Otolaryngology-Head and Neck SurgeryManisa Celal Bayar UniversityManisaTurkey
  3. 3.Department of Otolayngology-Head and Neck SurgeryUniversity of MichiganAnn ArborUSA

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