European Journal of Dermatology


Reconstruction methods for and cosmetic evaluation of external nasal tumour resections: flap versus graft Volume 33, issue 5, September-October 2023


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1 Division of Plastic and Reconstructive Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime, 791-0295, Japan
2 National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-chou, Iwakuni City, Yamaguchi, 740-8510, Japan
3 Department of Plastic and Reconstructive Surgery, Tokushima University Hospital, 2-50-1 Kuramoto-chou, Tokushima City, Tokushima, 770-8503, Japan
4 Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-chou, Tokushima City, Tokushima, 770-8539, Japan
5 National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-chou, Kure City, Hiroshima 737-0023, Japan
6 Eirikai Foundation Matsuyama Shiminn Hospital, 6-5, Otemachi 2-chome, Matsuyama, Ehime 790-0067, Japan
7 Okayama University Hospital, 2-5-15, Shikata-chou, Kita-ku, Okayama City, Okayama 700-8558, Japan
8 Uwajima Hospital, 1-1 Goten-cho, Uwajima City, Ehime, 798-8510, Japan
9 Department of dermatology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime, 791-0295, Japan
* Reprints: Asami Tozawa


Nose reconstruction is challenging given the three-dimensional structure and free edge, and various methods have been reported. In general, local flaps provide cosmetic outcomes that are better than those following skin grafts, but there are no published comparative studies on Asians.


To determine whether local flaps or skin grafts may optimally be used to reconstruct external nasal defects among Asians.

Materials & Methods

We retrospectively collected data on patients who underwent external nasal tumour resection and reconstruction by 14 plastic surgeons in eight Japanese institutes from 2009 to 2021. The cosmetic results were scored by 14 surgeons using anonymized preoperative and six-month postoperative photographs. Scores for each reconstruction method were statistically evaluated.


In total, 86 cases were enrolled; 57 received local flaps and 29 received skin grafts. Most local flaps showed better outcomes compared to skin grafts, but this was not the case for nasolabial and forehead flaps. Notably, local flaps placed in the nasal ala tended to be less successful than flaps placed elsewhere; only the bilobed flap scored better than skin grafts. The defect site did not affect the results of skin grafts.


For Asians requiring nasal reconstruction, local flaps provide better cosmetic outcomes than skin grafts, except for those in the nasal ala. Skin grafts may be a good alternative when the bilobed flap is unavailable for the nasal ala.