A severely shortened nose secondary to fracture of the middle third of the face was reconstructed by full-thickness tissue transfer with osteotomy. A nasalis musculocutaneous island flap, including the scar located in the nasal dorsum, was harvested for the lining. It was elevated based on the lateral nasal artery. The donor site defect of the flap and the covering defect were reconstructed with a forehead flap. The platform and framework of the nose were corrected with an en bloc osteotomy of the nasal bone, including the piriform aperture with a vascularized calvarial bone graft. Satisfactory and stable results were obtained in one stage along with the restoration of the relationships between the nose and the surrounding structures.
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