"West by East-West": combination repair of wide or multiple distal nasal defects.

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Surgical defects of the distal nose can pose reconstructive challenges when function, cosmesis, and morbidity are considered.We aim to present a reproducible, single-stage reconstruction of the distal nose when defects are wide, multiple, or span multiple cosmetic subunits.Retrospective case series of selected patients with distal nose defects repaired with the "West by East-West" combination flap.Three patients with distal nasal tip defects were identified to show the use of the "West by East-West" combination flap, and one of these patients had an adjacent full-thickness skin graft as part of the reconstruction.A combination of CAF and BAF is useful for distal nasal reconstruction when the surgical defect is greater than 2 cm, spans multiple subunits like the nasal tip/supratip/dorsum/sidewall/ala, and where CAF or BAF alone would distort the free margins or give insufficient laxity for defect closure. In our experience, the BAF accomplishes the required medially based laxity with superior cosmesis and less nasal asymmetry created by the redundancy of a traditional medially based back cut. The combination repair can also be used for simultaneous repair of multiple distal nasal defects.The "West by East-West" reconstruction is designed to incorporate the CAF and the BAF utilizing the paranasal cheek tissue reservoir, midline nasal dorsum supra-perichondrial movement, and a shared standing tissue cone (STC). It provides a reproducible, single-stage reconstruction of the distal nose when defects are wide, multiple, or span multiple cosmetic subunits.


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