title: A new alternative for reconstruction of the inferior medial canthal and nasal sidewall defects.
abstract: BACKGROUND
  Reconstruction of the inferior medial canthal and nasal sidewall defects presents some particular problems resulting from the unique anatomy of this region such as the multiple contours and sigmoidal relaxed skin tension lines, differences in skin color and texture, and the anatomic limitations presented by the adjacent structures including lower eyelids, eyebrows, and lacrimal drainage system.
  
  
  OBJECTIVE
  In this study, the authors represent a new local flap as a new alternative for reconstruction of the defects of the inferior medial canthal region and nasal sidewalls.
  
  
  METHODS
  In this technique, defect closure is achieved by using 2 cutaneous flaps designed in an unequal z-plasty manner. The first flap is used to cover the defect, whereas the second flap is used for closure of the first flap's donor site. From October 2006 to May 2010, a total of 16 patients 38 to 80 years old underwent medial canthal and nasal sidewall reconstruction by using this procedure. The defect size ranged from 2.0 to 3.2 cm in width.
  
  
  RESULTS
  A tension-free defect closure was achieved in all patients. Except 1 patient who had slight pseudoepicanthus, there was no patient with distortion of the surrounding anatomic structures. During a mean follow-up period of 30 months (5 months to 3½ years), all patients were satisfied with the cosmetic and functional results. Except 1 patient who underwent reoperation for tumor recurrence, no patient required further surgery.
  
  
  CONCLUSIONS
  The reading man procedure was found to be a successful technique for the closure of inferior medial canthal and nasal sidewall defects. It allows tension-free closure of considerably larger defects without any additional healthy tissue excision and and/or dog ear formation. Moreover, using z-plasty principle, it avoids distortions of the surrounding mobile anatomic structures.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Mutaf
authors.forename: Ertan
authors.initials: E
authors.lastname: Günal
mesh_terms: D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009669:Nose Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome