The flap described is based totally on subcutaneous connections and depends on the blood supply in this tissue for its survival. The amount of advancement is limited mainly by the vertical depth of subcutaneous tissue between the skin and the underlying bone or cartilage and, to a lesser extent, on the looseness of the tissue distal to the defect. This distal tissue “back-slides” into the defect as the advancement flap pedicle applies a force in the direction whence it came (6). The skin of the nostril is relatively unyielding, and therefore most of the mobility rests in the flap itself.

In areas on the lateral surfaces of the nose where the subcutaneous tissue is relatively thick, large subcutaneously based flaps can be developed and advanced with excellent results. Because of the excellent blood supply of the nose, undermining of these flaps can be performed to a significant extent, without injuring or compromising the flap. Most of these flaps in the lateral nose and medial face are, in actuality, musculocutaneous flaps fed by vessels from small underlying facial muscles (6).