Reconstructive techniques in cutaneous defects of the nasal tip

Many techniques are used for repairing nasal tip defects. Our own guidelines are reviewed: Small defects often can be closed directly. Lesions of the nasal tip over 0.5 cm in diameter usually require a skin graft or flap. Postauricular, preauricular, and nasolabial full-thickness skin grafts may produce noticeable color or contour differences. The type of local skin flap used depends on defect size: Local rotation-transposition flaps or the nasalis myocutaneous sliding flap described by Rybka are used for defects 2 cm or less in diameter. Rieger and de Marchac frontonasal flaps are used for defects 2-3.5 cm in diameter. Forehead flaps are used for defects of 3.5 cm or more. We prefer Rybka's flap for nasal tip defects less of 2 cm because it has cosmetic advantages: incisions do not deform natural cutaneous crease lines and chronic edema and "dog ears" secondary to rotation-transposition pedicle flaps are avoided. For more extensive defects, we prefer frontonasal or forehead flaps.