title: The Z-advancement flap for reconstruction of lateral nasal tip and medial alar defects.
abstract: BACKGROUND
  Reconstruction of lateral nasal tip and medial alar defects is challenging. Contour, symmetry, and skin texture of the nose, along with adequate nasal airway patency, should be preserved. The Z-advancement flap is a novel reconstruction technique designed for optimal cosmesis and function.
  
  
  OBJECTIVE
  To evaluate the aesthetic and functional outcomes of Z-advancement flap nasal reconstruction.
  
  
  METHODS
  Twenty-nine consecutive patients with defects 1 cm or less in diameter on the lateral nasal tip or medial ala underwent Z-advancement flap repair. Patients completed a survey assessing cosmesis and airway patency. Three physicians evaluated standardized photographs on visibility of scar lines, erythema and telangiectasia, and contour and symmetry of the ala and nostril opening.
  
  
  RESULTS
  Twenty-eight (96%) patients completed survey questionnaires. All patients were satisfied with the look and feel of their reconstructed nose. Twenty-four (86%) saw no visible scar or abnormality. Postoperative photographs were available for review in 19 (66%) patients. In 95% to 96% of physician ratings, scars were invisible or visible only on close inspection, and alar symmetry was unchanged or only slightly altered. In 88%, nostril opening symmetry was unchanged or slightly altered.
  
  
  CONCLUSIONS
  The Z-advancement flap preserves aesthetic subunits of the nose to produce excellent cosmesis and patient satisfaction for defects of the lateral nasal tip or medial ala 1 cm or less in diameter.
authors.affiliation: Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Eberlin
authors.forename: Bichchau
authors.initials: B
authors.lastname: Nguyen
authors.forename: Pritesh S
authors.initials: PS
authors.lastname: Karia
authors.forename: Joi B
authors.initials: JB
authors.lastname: Carter
authors.forename: Christine A
authors.initials: CA
authors.lastname: Liang
authors.forename: Chrysalyne D
authors.initials: CD
authors.lastname: Schmults
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009669:Nose Neoplasms / Q000601:surgery*; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D016896:Treatment Outcome