Cheek Advancement Flap Research Articles

Hidradenocarcinoma of Nose: A Rare Case Report.

This report details the surgical management of a rare case of hidradenocarcinoma in a 70-year-old man presenting as a large multilobulated swelling on the dorsum of the nose. Following histopathological confirmation, the patient underwent wide complete excision of the tumour, coupled with sentinel lymph node dissection. Reconstruction involved the use of a paramedian forehead flap and cheek advancement flap. The successful outcome underscores the importance of early diagnosis and a comprehensive surgical approach for managing hidradenocarcinoma on the nasal dorsum.

Glabellar rotation flap technique in patient with squamous cell carcinoma in right upper eyelid: case reports

Introduction : Squamous cell carcinoma (SCC) is the second most common skin malignancy after basal cell carcinoma, with an increasing incidence worldwide. Found in various parts of the body, in the eye and periocular area, it may affect the skin of the conjunctiva, cornea, and eyelid. Surgical excision is the preferred mode of SCC treatment. After excision, reconstructive surgery is often required for the best functional and cosmetic results. Early diagnosis and treatment of tumors and follow up care for at least 5 years have a significant impact on patient survival.
 Case Illustration: Description of two cases squamous cell carcinoma that had undergone reconstructive biopsy and blepharoplasty procedure with glabellar rotation flap technique alone in one case and together with a cheek advancement flap in the second one. In both cases, conjunctival replacement by using lower labial mucosa.
 Discussion : In both cases tumor affects the margin of the upper eyelid, therefore flap reconstruction is necessary to maintain eyelid function and esthetics. The glabellar flap has the advantages of being a fast surgery, having a good vascular supply, and being able to fill deep abnormalities because it is a thick flap. A cheek lateral rotation flap was designed to avoid unnecessary facial distortion in second case.
 Conclusion : Glabellar rotation flap alone or together with cheek advancement flap was done to maintain function and physical aesthetic of eyelid. Additional cheek lateral rotation flap could reduce skin tension.

Study of facial reconstruction in basal cell carcinoma

Head and neck reconstruction presents unique challenges as the defects of this region are often difficult to conceal and the demands on the surgeon’s reconstructive skills are greater than they are elsewhere in the body where cosmesis may be less vital and function less specialized. Reconstruction depends on the size as well as the location of the defect. Smaller defects created after excision can be covered by local flaps, however larger defects require a combination of flaps such as rotation, transposition, and cheek advancement. Defects located over and beyond the hairline can be covered by skin grafting as well. We have taken 10 such cases of basal cell carcinoma and explained the various surgical procedures performed on the patients. In 4 of the patients, defect was covered via grafting and in the remaining 6 patients, a combination of forehead flap and cheek advancement flap was done. All the cases have shown excellent functional as well as cosmetic result.

Aesthetic subunit reconstruction of basal cell carcinoma face

Background: Arising from the basal cell layer of epidermis; BCC is one of the most common cutaneous malignancy encountered in elderly (77%) followed by SCC (20%) and malignant melanoma (3%). Method: A prospective observational study was conducted at department of plastic and reconstructive surgery with 50 patients included for over a span of 2 years. Patients with biopsy confirmed BCC lesion over face were included and were grouped on the basis of subunit involved and type of flap done. Results: The 50 patients were included which comprised of 16(32%) males and 34 (68%) females. Mean age was 61±10.2 years. Smallest defect size was of 1.5 cm2 whereas largest defect size was of 5 cm2. Cheek was the most common site of occurrence. Cheek advancement flap was the most commonly performed flap. Conclusions: Reconstruction of facial subunit post BCC excision with local tissue has superior aesthetic outcome in terms of colour and texture than any other modality.

Making Headway in Surgical Education at Home and Abroad: Use of an Inexpensive Three-Dimensional Learning Model to Improve Plastic Surgery Resident Confidence in Mohs Defect Assessment and Closure Planning.

The development of simulation, particularly low-cost models, has become a focus of interest within plastic surgery education. Current simulators for Mohs reconstruction are either expensive or not reusable. The authors hypothesize that using a Styrofoam head model during an interactive teaching session will positively affect plastic surgery trainee comfort in designing Mohs reconstructive options. A cohort of integrated plastic surgery residents at a single institution performed a preactivity questionnaire to obtain baseline comfort in defect assessment and design for five Mohs defects. They subsequently underwent an interactive learning session and were instructed to design flaps on life-size Styrofoam heads with feedback from the senior author (M.L.B.). A postactivity questionnaire was completed to assess improvement in comfort in defect assessment and flap design. Three attending surgeons then compared trainee designs with the senior author's design to assess accuracy. All surveys were based on a five-point Likert scale. When analyzing all defects, average postactivity scores increased by 0.63 (SD, ±0.24) ( P = 0.008). Junior residents ( n = 8) had a greater increase in average score responses [mean, 1.07 (0.5 to 1.75)] compared with senior residents ( n = 9) [mean, 0.27 (0 to 1)] ( P < 0.001). When assessed by senior-level surgeons, senior residents had significantly greater accuracy in design for each defect ( P < 0.05) except cheek advancement flap ( P = 0.08). Participation in an interactive educational activity using a Styrofoam head model demonstrated significant improvements in trainee assessment and design of reconstructive options for Mohs defects.

Applying Occam's Razor and Descending the Reconstructive Ladder: The Modified Cheek Advancement Flap for Reconstruction of Nasal Defects.

Nasal reconstruction has important functional and cosmetic considerations, as proper repair of nasal defects is necessary to maintain function of the nasal airway and to recreate the normal appearance of this central facial structure. Cheek advancement flaps provide matched, mobile, and highly vascularized tissue for the reconstruction of nasal defects, allowing for the concealment of incisions within natural creases in a one-stage approach. However, cheek advancement flaps are often underutilized for nasal reconstruction because of their difficulty in restoring nasal contour. We describe reconstruction of 19 nasal dorsal and sidewall defects 0.8 to 3 cm in size. We incorporated a periosteal anchoring suture to maintain/restore nasal contour and additionally removed a half standing cone inferior to the defect to prevent encroachment of the nasal ala or alar crease. All patients were evaluated at least 3 months postoperatively. In all patients, we were able to restore concavity of the nasofacial sulcus, preserve the biconvex nasal tips, prevent alar flaring and retraction, and conserve the alar groove. All patients had excellent functional and cosmetic outcomes. We believe this modified cheek advancement flap provides functionally and aesthetically superior results and can be considered as a first-line approach for repair of nasal dorsal and sidewall defects in subselected patients.

Various local facial flaps for traumatic and surgical facial defects

Aims: This study aimed to analyze the various modalities of reconstruction using local flaps for facial defects that occur after surgical excision and trauma and their advantages and disadvantages. Materials and Methods: A retrospective analysis was performed for 65 cases (age group from 20-45 years) with small to medium-sized facial defects from various causes over a period of 5 years. Patients with immunodeficiency, terminal illnesses and head injury were excluded. Treatment methods depended on size and location of defect. Results: Of the 65 patients, 15 had nasolabial flaps, 6 had V-Y advancement flaps, 3 had cheek advancement flaps, 2 had forehead flaps, 2 had Limberg flaps, 20 had fillet flaps and 17 were bilateral advancement flaps. Postoperatively none developed complications with acceptable functional and aesthetic outcome which were excellent in 55 patients, good in 5 patients and fair in 5 patients after 6 months of follow up. Conclusions: Local facial flaps are a simple, easy and versatile option to reconstruct small to medium sized facial defects and provides a good match with adjacent skin thus providing good aesthetic and functional results along with fast recovery.

A Bipedicled Lip Switch Flap From the Upper Lip for Delayed Re-Do Total Lower Lip Reconstruction: A Case Report

Several different techniques have been described for reconstructing vermilion lip defects. The key to successful reconstruction of the vermilion is to restore the original esthetic landmarks and appearance of the lip while preserving function. We present a case of a 49-year-old patient with a history of lower lip squamous cell carcinoma who presented to our institution status post resection and reconstruction with Bernard-von Burow cheek advancement flaps with Webster modification at an outside hospital. Her main complaint was the lack of lower lip vermillion and loss of lip height. This new defect was repaired using a bipedicled lip switch flap from the upper to lower lip. To our knowledge, this is the first time this technique has been reported in the literature to reconstruct a total vermilion lower lip defect. A bipedicled lip switch flap offers an alternative, reliable method for the repair of large vermilion lip defects that can produce satisfactory esthetic and functional outcomes.

Near Total/Total Lower Lip Reconstruction—Chin Rotation Advancement Flap

Summary: Total lower lip reconstruction is a challenging reconstruction procedure. Its main role is to restore lip function, maintain the proper relationship between the upper and lower lips and optimize cosmesis. Various techniques ranging from local flaps to free tissue transfer have been developed. For patients who are not candidates for microsurgical techniques or for those who do not want complex procedures, the local flap technique is a good solution. Most of the reported techniques, based on cheek advancement and nasolabial flaps, lead to scars located in the midface and therefore to unaesthetic results. We hereby present a novel technique for total lower lip reconstruction using a rotation advancement flap based on the excess tissue of the lower face. To our knowledge, this method has not been described previously in the literature.

Reconstruction of large facial defects using a combination of forehead flap and other procedures.

BackgroundReconstruction of large facial defects is challenging as both functional and cosmetic results must be considered. Reconstruction with forehead flaps on the face is advantageous; nonetheless, reconstruction of large defects with forehead flaps alone results in extensive scarring on the donor site. In our study, the results of reconstruction using a combination of forehead flaps and other techniques for large facial defects were evaluated.MethodsA total of 63 patients underwent reconstructive surgery using forehead flaps between February 2005 and June 2020 at our institution. Reconstruction of a large defect with forehead flaps alone has limitations; because of this, 22 patients underwent a combination of procedures and were selected as the subjects of this study. This study was retrospectively conducted by reviewing the patients’ medical records. Additional procedures included orbicularis oculi musculocutaneous (OOMC) V-Y advancement flap, cheek advancement flap, nasolabial V-Y advancement flap, grafting, and simultaneous application of two different techniques. Flap survival, complications, and recurrence of skin cancer were analyzed. Patient satisfaction was evaluated using questionnaires.ResultsAlong with reconstructive surgery using forehead flaps, nasolabial V-Y advancement flap was performed in nine patients, local advancement flap in three, OOMC V-Y advancement flap in two, grafting in five, and two different techniques in three patients. No patient developed flap loss; however, cancer recurred in two patients. The overall patient satisfaction was high.ConclusionReconstruction with a combination of forehead flaps and other techniques for large facial defects can be considered as both functionally and cosmetically reliable.

Eyelid Reconstruction: An Algorithm Based on Defect Location.

Eyelid reconstruction is a complex topic. This review looks at articles from 1990 to 2018 on eyelid reconstruction that had at least 10 patients and a mean 6 month follow-up. The authors present the results of our findings and propose an algorithm to guide the surgeon in choosing the best technique based on location, size, and lamella. Defects less than 1/3rd of the upper or lower eyelid may be closed primarily. Anterior and posterior lamella defects of the lower eyelid greater than 1/3rd in size should be reconstructed with a double mucosal and myocutaneous island flap. Those greater than 50% in size should be recreated with a Tripier flap for the anterior lamella and conchal chondroperichondral graft for the posterior lamella. For total lid reconstruction, a Fricke flap is best for the anterior lamella and the tarsoconjunctival free graft/lateral orbital rim periosteal flap is best for the posterior lamella. Fullthickness defects between 1/3rd and 2/3rd in size of the upper eyelid should be reconstructed with a myotarsocutaneous flap and those greater than 2/3rd should be reconstructed with a Cutler-Beard flap for the anterior lamella and auricular cartilage for the posterior lamella. For the medial canthal region, the island pedicle and horizontal cheek advancement flap is recommended for the anterior lamella and a composite upper lid graft for the posterior lamella. For the lateral canthal region, a bilobed flap is recommended for the anterior lamella and a periosteal flap for the posterior lamella.

Is reconstruction of composite defects of nose and cheek following tumor excision utilizing subunit principle the best?

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Composite defects of nose and cheek are best stage reconstructed with separate nose and cheek flaps to recreate a blended nose-cheek junction, achieved by cheek advancement flap for cheek and forehead flap or local grafts for the nasal defect. This article analyses whether reconstruction of defects utilizing well-known subunit principle is cosmetically the best?&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Case records of fifteen patients of nasal cancers extension into the cheek from January 2011 to December 2015 were analyzed retrospectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of fifteen patients 8 were men and 7 women, two patients had SCC, rest had BCC. Average size of defect was 4.5 cm. Modified Imre’s cheek advancement flaps was used in all to reconstruct cheek defects while paramedian forehead flap was used for nasal reconstruction in 13 patients, skin graft and nasal advancement flap in one each. Eight patients underwent single stage reconstruction while seven with full thickness nasal defects had a delayed reconstruction. 13 patients rated their final appearance as satisfactory, while surgeon rated 12 patients with well-blended nose-cheek junction as satisfactory and lateral migration of junction being unsatisfactory. Alar retraction was observed in two patients with full thickness nasal defects. Two patients who underwent inner nasal lining reconstruction developed wound dehiscence while simultaneous reconstruction of nose and cheek was performed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Subunit principle application for composite nose and cheek results in symmetrical nose-cheek junction and appears excellent technique in achieving a satisfactory aesthetic outcome. Optimal results in full thickness nasal defects are achieved where reconstructing is delayed.&lt;/p&gt;

Cheek advancement flap for nasal reconstruction following surgical excision of basal cell carcinoma: early outcome and patient satisfaction

Background Many reconstructive techniques have been used for reconstruction of the nose after wide excision of basal cell carcinoma (BCC) with variable esthetic outcome. Patient satisfaction is a crucial determinant of the reliability of any reconstructive technique. Aim The aim of this prospective clinical study was to evaluate the cutaneous cheek advancement flap as a reliable method for nasal reconstruction following wide excision of BCC regarding early postoperative complications and patient satisfaction. Patients and methods The current study included 51 patients with BCC at side of nose who are eligible for wide excision and immediate reconstruction using cutaneous cheek advancement flap. Follow-up was planned for 3 months to report early postoperative complications. Esthetic outcome was assessed using Likert score and Vancouver’s scar scale. Results The age of the included patients ranged from 46 to 63 years. The current study showed wound infection in 3.9% of patients, seroma occurred in three patients, whereas hematomas occurred in two patients. No total flap loss was reported, whereas partial flap loss occurred in one (1.9%) case. The patients’ overall satisfaction was good, and only two (3.9%) patients showed poor esthetic outcome. There was a strong positive correlation between patients’ evaluation and independent surgeons’ assessment (r=0.922). Conclusion According to the current results, cheek advancement flap is a feasible and simple method for reconstruction of medium-sized and large-sized defects in the side wall of the nose with minimal postoperative complications and excellent esthetic outcome.

Combination of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option in orbital exenteration.

To describe a combinatory technique made of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option after orbital exenteration. We retrospectively reviewed all patients who underwent orbital exenteration and subsequent reconstruction with this technique at our Head and Neck Department, Divisions of Ophthalmology and Otolaryngology, at San Raffaele Hospital, Milan, Italy. Three patients were treated with the aforementioned technique, following orbital exenteration due to malignancies. All of them were affected by recurrent diseases arising from the ocular components or periorbital structures: one basal cell carcinoma and two squamous cell carcinomas. Excellent result was achieved considering skin texture and colour match, aesthetic results and intra and post-operative complications (only minor, surgically controlled haemorrhage and minimal dehiscence subsequent to defective healing occurred). The proposed technique can be considered by the head and neck reconstructive surgeon as a good option in extended orbital exenteration.

Reconstruction of Orbital Exenteration Defect With Cheek or Combined Cheek and Forehead Advancement Flaps.

To review the outcomes of orbital exenteration defect reconstruction using cheek or combined cheek-forehead advancement flap. Charts of 14 patients who underwent reconstruction of the exenterated orbit with cheek advancement flap were reviewed. In surgery, a cheek flap elevated via a nasofacial sulcus incision, and preperiosteal dissection was advanced over the defect. The upper orbital defect, if necessary, was covered with a forehead flap, which was dissected through an incision in the midline or temporal forehead and advanced inferiorly. In all patients (7 women, 7 men; mean age, 65 years), total (n = 7) or extended (n = 7) exenteration was performed for a malignant tumor. In 12 patients (86%), the defect was primarily closed with cheek flap alone (n = 6) or cheek plus forehead (n = 6) advancement flaps. Eight patients received radiotherapy before and after surgery. Four patients (29%) had a total of 6 postoperative complications (skin graft infection, orbital cavitary abscess, osteomyelitis, chronic skin ulcer, and 2 sino-orbital fistulae). The mean follow-up duration was 43 months (range, 11-79 months). Cheek advancement flap can be used alone or together with a forehead advancement flap to cover the orbital defects after total or extended exenteration. This repair may be resistant to radiotherapy-related complications in some cases.

Modified cheek advancement flap for medial lower eyelid, nasal sidewall and infraorbital cheek reconstruction: a case series

ABSTRACTAim: To describe and evaluate surgical outcomes of the Modified Cheek Advancement Flap (MCAF) to reconstruct defects involving medial lower eyelid, nasal sidewall and infraorbital cheek following Mohs micrographic surgery for basal cell carcinoma (BCC).Materials and Methods: All patients who underwent MCAF between 2012 and 2018 under the care of a single surgeon (LCA) were identified. The technique described in this report is a significant modification of the traditional cheek advancement flap. The MCAF was undertaken without subciliary or infraorbital incisions, less extensive dissection and use of flap advancement rather than rotation. A retrospective chart review was completed using a pro-forma which included risk factors for flap failure, early and late complications and additional reconstructive procedures. Patient satisfaction was rated using a five-point Likert-type scale.Results: 42 patients underwent the MCAF. Mean follow up was 28.4 months (±19.9 months). Early complications were found in 11.9% of the patients and resolved completely within the first four post-operative weeks. There were no long term complications secondary to the reconstruction. No lower eyelid ectropion was noted. 78.6% of the patients cited they were ‘extremely satisfied’ with the final cosmetic outcome.Conclusion: The MCAF proves a valuable and safe option in periocular reconstructive surgery with excellent cosmetic results and no post-operative ectropion. The necessity for eyelid tightening as part of the reconstructive process should encourage oculoplastic surgeons to use the MCAF when reconstructing defects involving medial lower eyelid, infraorbital cheek and nasal sidewall.

Local facial flaps: a workhorse for reconstruction of facial malignancies defects

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Face represents complete personality of a human being, so adequate cosmetic correction of facial defects arising due to skin malignancy is very important. After excision, treatment option varies according to size and location of defect for small- or moderately-sized circular defects. In our study, we have evaluated versatility of local flap of face.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We have included 30 cases of skin malignancy on face in our Institute within the period of June 2016 to May 2018. 20 patients (66.6%) were male and 10 patients (33.3%) were female, in age group from 45 to 65 years. 17 cases had basal cell carcinoma, 10 cases had squamous cell carcinoma and 3 cases had malignant melanoma. Tumours were excised with safe margins and defects reconstructed with local facial flaps. We evaluated the early postoperative complications and after 6months, cosmetic outcome and patient satisfaction was evaluated. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 30 patients with small to medium-sized defect (3-6 cm), 8 cases were managed with V-Y advancement flap, 7 cases nasolabial flap, 8 cases forehead flap and, 4 cases Limberg flap, 4 cases cheek advancement flap. Postoperatively none of the cases had complications and the functional and aesthetic outcomes were quite acceptable. Aesthetic results were excellent in 15 patients (50%), while in 8 patients good results (27%) and 5 patient fair results (17%) after 6 month.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Local facial flaps are the simple and best option to reconstruct the small to medium size facial malignancies defects and provides excellent skin colour and texture match with gives good aesthetic result.&lt;/p&gt;

A Combination Flap for Nasal Defect Reconstruction.

Nasal reconstruction is a common plastic surgery procedure following cancer resection. Whereas most small and medium defects are managed using standard local flaps, reconstructive options available for large defects of the nose such as a heminasal defect are very few. Most of the large defects are usually managed using a forehead flap, which involves at least 2 stages or using free tissue transfer. The author describes a combination flap that can be used for reconstruction of heminasal defects as well as lateral wall defects. A cheek advancement flap with the nasolabial flap incorporated in it as a combined flap was used for reconstructing heminasal defects and lateral wall defects in 11 patients. Four of the cases were following Mohs surgery for skin cancer, and others, primary reconstruction following wide excision of skin cancer. Five of the cases required cartilage support with or without lining, and others were skin-only defects. All were done as single-stage procedures. The cases were followed up over a period ranging from 6 to 18 months. There were no immediate complications in any of the cases, and all flaps survived completely. Assessment was done in terms of function, appearance, requirement for further procedures, and patient satisfaction. Outcome was deemed excellent in 8 patients. One patient had deviation of the nasal septum, and 2 patients had cheek scars in an unfavorable direction. The combination flap is a simple, single-stage procedure useful for reconstruction of heminasal and lateral wall defects. This technique is easily reproducible and provides consistently good results.

The Arkansas Tessier Number 3 Cleft Experience: Soft Tissue and Skeletal Findings With Primary Surgical Management: Four-Step Approach

Tessier No 3 facial cleft (oro-nasal-ocular clefts) is the rarest and most challenging of all the Tessier clefts. Reports on Tessier No 3 clinical findings, surgical techniques, and outcomes are varied due to the scarcity of patients and the wide range of phenotypic findings. The authors present our experience of 2 children born with Tessier No 3 clefts who were both managed at the Arkansas Children's Hospital. Our purpose is to add knowledge on this rare craniofacial cleft by providing detailed soft tissue findings, skeletal findings, operative techniques, early postoperative outcome, and suggestions of a treatment protocol.Both were born at 38 weeks gestation and had multiple associated anomalies including: syndactyly, limb anomalies, cardiac defects, and encephalocele in Patient 1 and hydrocephalus and dysphagia in Patient 2. While both patients had a bilateral cleft lip and palate, Patient 1 had a severe left-sided cleft and Patient 2 had a right-sided incomplete cleft. A multidisciplinary team of specialists in Plastic Surgery, Otolaryngology, and Oculoplastics were assembled to devise a top-down approach for repair. In brief, our surgical sequence for both infants was a dorsal nasal Reiger flap to level the ala, cheek advancement flap along with medial canthal repositioning, and more traditional bilateral cleft lip repair using a modified Millard technique. Postoperatively, Patient 1 experienced some early scarring, medial canthal rounding, lagophthalmos, and cicatricial retraction of the lower lid and patient 2 demonstrated under-correction of the displaced ala but had satisfactory medial canthal position.Future evaluations will include serial photography and annual 3-dimensional computed tomography scans to evaluate the soft tissue and bony growth. After these initial procedures, both infants will be followed for routine cleft clinical and surgical care.

Combination of Melolabial Interpolation Flap and Nasal Sidewall and Cheek Advancement Flaps Allows for Repair of Complex Compound Defects.

The paramedian forehead flap (PMFF) is the repair of choice for large nasal defects involving multiple cosmetic subunits. However, the PMFF may not be optimal for all patients. The combination of a melolabial interpolation flap (MLIF) and a nasal sidewall flap may serve as an alternative. To present the surgical technique and aesthetic outcomes of the alternative reconstruction for surgical defects of the lower nose. Fourteen patients with multisubunit nasal Mohs defects reconstructed alternatively were identified from 2 academic centers in this retrospective case series. Illustrations and photographs were used to demonstrate surgical technique and outcomes. Final aesthetic results were analyzed using the Patient and Observer Scar Assessment Scale. The physician observer rated the scar outcome a mean score of 10.9 ± 3.3. Patients rated their results as a mean of 9.1 ± 4.7. The mean "Patient" Overall Opinion score was 2.3 ± 2.6 and the mean "Observer" Overall Opinion score was 1.9 ± 0.9. No patients reported problems with nasal airflow or obstruction, and cosmetic complications such as pincushioning or alar buckling were not observed. The combined MLIF and nasal sidewall flap is an alternative repair for complex distal nasal defects.