Non-treatment as a valuable treatment option in older adults with basal cell carcinoma?

The aim of this study is to describe this variant of the NTF and its main clinical, aesthetic, and functional outcomes.Methods: Multicenter retrospective case series.Patients who developed a midline nasal defect (at least involving the tip and/or dorsum) after oncologic surgery and were reconstructed with an NTF were included.The surgeons who performed the procedures evaluated functional and aesthetic outcomes using a scale from 1 to 10.Results: Eight patients were identified, 3 women and 5 men, with a mean age of 69 years.In all cases, the excised tumor was a basal cell carcinoma, except for one squamous cell carcinoma.Mohs micrographic surgery was used in all but one case.The mean resulting defect size was 3.3 cm.In 5 cases, the involved subunits were the nasal dorsum and tip, and in 3 cases, the tip and ala.The flap was designed unilaterally in 5 cases and bilaterally in the remaining 3. In one case, auricular helix cartilage was additionally used to provide structural support.No complications were observed except for one case of partial necrosis in a bilateral flap.One patient required a secondary aesthetic revision.The mean follow-up after flap reconstruction was 6 months.The mean functional outcome score was 9.5/10 and the mean aesthetic outcome score was 7.8/10. Conclusions:The NTF may represent an alternative to the PFF for extensive defects of the nasal dorsum and tip, with good clinical, functional, and aesthetic outcomes.Its advantages include avoiding unaesthetic forehead scars and allowing reconstruction in a single stage, which is particularly beneficial in elderly patients.The unilateral design appears to provide better reconstruction according to anatomic subunits and may carry a lower risk of necrosis than the bilateral design due to a wider pedicle