title: Reconstructive perspectives of cutaneous defects involving the nasal tip: a retrospective review.
abstract: OBJECTIVE
  To create an algorithm that derives our preferred reconstruction technique for cutaneous defects involving the nasal tip and to review the management and outcomes of patients with nasal tip cutaneous defects after their initial reconstruction.
  
  
  METHODS
  A retrospective review of patients undergoing repair of cutaneous defects involving the nasal tip between January 2006 and January 2009. After data compilation, a defect-based algorithm deriving our repair technique was created.
  
  
  RESULTS
  Seventy-two patients were identified: 57% underwent full-thickness skin graft repair (n = 41), 19% underwent forehead flap repair (n = 14), and 17% underwent bilobe flap repair (n = 12). The remaining 7% underwent repair using nasal cutaneous flaps harvested adjacent to the defect (n = 5). Nasal tip defect involvement of an adjacent nasal aesthetic unit was the most critical factor in selecting a reconstruction technique. Further categorization by the presence of nasal ala involvement, cartilage exposure, and defect surface area allowed reliable prediction of our reconstruction technique. Dermabrasion was routinely performed early in the postoperative course (25% [18 of 72 patients]). Corticosteroid injection was commonly used for those undergoing forehead flap (71% [10 of 14 patients]) and bilobe flap (50% [6 of 12 patients]) repair. Aesthetic revision surgery was infrequently required (15% [11 of 72 patients]). All aesthetic outcomes were good or satisfactory.
  
  
  CONCLUSIONS
  The included algorithm offers a systematic approach for managing cutaneous defects involving the nasal tip and derives our preferred technique with high reliability.
authors.affiliation: Department of Otolaryngology, University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109-5212, USA. ryancoll@med.umich.edu
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Collar
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Ward
authors.forename: Shan R
authors.initials: SR
authors.lastname: Baker
mesh_terms: D000368:Aged; D000465:Algorithms; D002280:Basal Cell Carcinoma / Q000601:surgery; D003661:Decision Support Techniques; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D008875:Middle Aged; D015580:Mohs Surgery / Q000009:adverse effects; D009667:Nose Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D009669:Nose Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D012878:Skin Neoplasms / Q000601:surgery; D016038:Skin Transplantation; D016896:Treatment Outcome