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The Z-Advancement Flap for Reconstruction of Lateral Nasal Tip and Medial Alar Defects

Eberlin, Kyle, R., MD1; Nguyen, Bichchau, MD2; Karia, Pritesh, S., MPH2; Carter, Joi, B., MD3; Liang, Christine, A., MD2; Schmults, Chrysalyne, D., MD, MSCE2

doi: 10.1111/dsu.12409

BACKGROUND Reconstruction of lateral nasal tip and medial alar defects is challenging. Contour, symmetry, and skin texture of the nose, along with adequate nasal airway patency, should be preserved. The Z-advancement flap is a novel reconstruction technique designed for optimal cosmesis and function.

OBJECTIVE To evaluate the aesthetic and functional outcomes of Z-advancement flap nasal reconstruction.

MATERIALS AND METHODS Twenty-nine consecutive patients with defects 1 cm or less in diameter on the lateral nasal tip or medial ala underwent Z-advancement flap repair. Patients completed a survey assessing cosmesis and airway patency. Three physicians evaluated standardized photographs on visibility of scar lines, erythema and telangiectasia, and contour and symmetry of the ala and nostril opening.

RESULTS Twenty-eight (96%) patients completed survey questionnaires. All patients were satisfied with the look and feel of their reconstructed nose. Twenty-four (86%) saw no visible scar or abnormality. Postoperative photographs were available for review in 19 (66%) patients. In 95% to 96% of physician ratings, scars were invisible or visible only on close inspection, and alar symmetry was unchanged or only slightly altered. In 88%, nostril opening symmetry was unchanged or slightly altered.

CONCLUSIONS The Z-advancement flap preserves aesthetic subunits of the nose to produce excellent cosmesis and patient satisfaction for defects of the lateral nasal tip or medial ala 1 cm or less in diameter.

1Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,

2Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts,

3Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,

Address correspondence and reprint requests to: Chrysalyne D. Schmults MD, MSCE, Department of Dermatology, Harvard Medical School, Mohs and Dermatologic Surgery, Brigham and Women's Hospital, 1153 Centre Street, Suite 4349, Jamaica Plain, Massachusetts 02130, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2014 by the American Society for Dermatologic Surgery, Inc.
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