title: Back to basics: reconstruction of defects on the lower half of the nose.
abstract: BACKGROUND
  Surgical reconstruction of defects on the lower half of the nose mandates special considerations. Simple excision and suturing might cause a depressed scar and nostril flaring. Hence, the preoperative plan should be designed properly to avoid disfigurement and to achieve a successful reconstruction.
  
  
  OBJECTIVE
  Three basic reconstructive concepts are essentially combined: 1.) The ratio between scar length and defect diameter should be extended beyond the standard 3:1 ratio; 2.) The defect should be positioned asymmetrically within the inferior half of the excision outline; and 3.) Para-median defects mandate an inferior, horizontal advancement ("sliding") flap to avoid nostril flaring. A salvage technique is also discussed.
  
  
  METHODS
  Data from patients treated by Mohs micrographic surgery for tumors of the inferior aspect of the nasal dorsum and reconstructed according to the proposed course of action was collected and reviewed.
  
  
  RESULTS
  The proposed reconstructive path proved successful for all patients. Although one case required salvage skin grafting, all patients had aesthetically pleasing results. No postoperative complications were noted.
  
  
  CONCLUSIONS
  Simple excision and primary suturing is a viable method for treating lesions on the lower half of the nose, provided that the surgeon follows a set of basic reconstructive principles.
authors.affiliation: Mohs Micrographic Surgery Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Isaac
authors.initials: I
authors.lastname: Zilinsky
authors.forename: Nimrod
authors.initials: N
authors.lastname: Farber
authors.forename: Josef
authors.initials: J
authors.lastname: Haik
authors.forename: Oren
authors.initials: O
authors.lastname: Weissman
authors.forename: Hadar
authors.initials: H
authors.lastname: Israeli
authors.forename: Eyal
authors.initials: E
authors.lastname: Winkler
mesh_terms: D006801:Humans; D015580:Mohs Surgery / Q000009:adverse effects / Q000379:methods; D009666:Nose / Q000473:pathology* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012225:Rhinoplasty / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery; D013524:Surgical Flaps