In current practice, pedicle flaps from the arm have limited application in nasal reconstruction. The skin color is often a poor match with facial skin, certainly less satisfactory than that of forehead and clavicular skin flaps. The texture of the hairless skin of the anteromedial surface is too fine and the dermis too thin for effective total nasal reconstruction without the provision of additional support at a subsequent operation. The thinness of the skin, however, can be an advantage for coverage of an exposed nasal skeleton. The immobilization required is a most trying position for the patient and can result in permanent stiffness of the shoulder (9). The major advantage of the flap is that less time is required for a nasal reconstruction than with any of the other distant pedicle flaps, e.g., clavicular. Also, further facial scarring associated with forehead flaps can be avoided.

The Tagliacozzi flap is still the preferred flap in several situations (8). This flap should be used for total nasal reconstruction in children, preserving the forehead for definitive rhinoplasty later in life. It is also preferred for those in whom the forehead is not available, either because of a low hairline or because of the unacceptable aesthetic result of a skin graft on the residual forehead donor site. This is a real factor in darker-skinned patients (African-American, Latino, Indian), in whom hyperpigmentation of the graft is anticipated.