Lateral Nasal (Miter) Skin Flap
R. A. RIEGER
The blood supply of this flap has been established as the nasal angular vessels (see Chapter 50). These are usually left intact even if the flap is back cut significantly.
Nasal skin is difficult to match in color, texture, and thickness. It is therefore desirable to repair nasal defects with nasal skin. Since nasal skin is relatively inelastic, it takes a relatively large nasal skin flap to reconstruct a small nasal defect.
A glabellar flap has been described by Gillies, who noted that it should be used only for defects in the upper half of the nose. A similar but more extensive flap can be devised to close defects in the lower third of the nose, particularly on the tip and either side of the midline (1).
The flap is indicated for reconstruction of defects up to 2 cm in diameter on or near the nasal tip and similar defects on the dorsum of the nose near the midline. Defects near the cheek are better closed with other methods.
The nasal tip area has always been a difficult one to reconstruct, and available methods of repair have their limitations. Full-thickness skin grafts commonly become too red and are cosmetically unacceptable. There are many problems with island flaps.
Although the lateral nasal flap appears to introduce extensive nasal scarring, the resultant scar is very acceptable (Fig. 49.1B), and although the nasal tip is elevated, this is not obvious when the flap has healed.
The blood supply to the flap is through the base along the lateral side of the nose, and since no specific vessels are included in the base, it is a random-pattern flap (see Chapter 50 for axial modifications (2)).