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Reconstruction of the Nasal Infratip, Columella, and Soft Triangle

Goldman, Glenn D. MD

doi: 10.1097/DSS.0000000000000110
Original Article

BACKGROUND Tumors of the soft triangle and distal nose are common, and the wounds created when removing them are among the more challenging defects to repair.

OBJECTIVE Reconstruction of the soft triangle, infratip, and columella requires attention to form and function beyond what is usually needed in cutaneous surgery. The complexities of the anatomy demand meticulous planning and surgical execution. In this review, the goal is to provide the cutaneous surgeon with a logical approach to repair this challenging region.

METHODS Skin grafts, composite grafts, local flaps, and pedicle flaps are presented with pearls and pointers. Cartilage grafting for stability is reviewed and detailed. A step-by-step approach allows the surgeon to plan appropriately and execute repairs with excellence.

RESULTS Ten cases are reviewed in sequential photo format to demonstrate successful reconstruction of operative wounds from this challenging region of the nose.

CONCLUSION The most distal nasal contours pose many challenges for reconstruction. Success depends on a good knowledge of anatomy, rigorous planning, and superior surgical skills. Skin grafts, composite grafts, local and interpolated flaps are all options that need to be considered when recreating the delicate folds and contours of this region. Cartilage support may be needed to maintain structural integrity. With care, excellent outcomes are predictably achieved.

Division of Dermatology, Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, Vermont

Address correspondence and reprint requests to: Glenn D. Goldman, MD, Dermatology, Fletcher Allen Health Care, University of Vermont College of Medicine, 111 Colchester Avenue, WP-5, Burlington, VT 05401, or e-mail:

The author has indicated no significant interest with commercial supporters.

© 2014 by the American Society for Dermatologic Surgery, Inc. Published by Lippincott Williams & Wilkins
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