Local Flaps in Nasal Reconstruction Following Non-Melanocytic Skin Cancer Ablation

Background: The nose is a common site of non-melanocytic skin cancers owing to its central facial location and chronic sun exposure. Surgical ablation of these tumors often results in complex defects involving convex surfaces and aesthetically critical subunits. Local flap techniques are preferred over skin grafts because of their superior tissue matching, contour restoration, and structural integrity. However, selecting an appropriate flap based on defect characteristics is essential for achieving optimal outcomes. Materials and Methods: Between March 2024 and March 2025, 12 patients underwent wide excision and local flap reconstruction at a single institution. Flap selection was based on defect location, size, and depth, with techniques including bilobed, rotation, Limberg, advancement, and nasolabial flaps (angular artery-based). The surgical outcomes were assessed in terms of flap viability, complications, revision requirements, and nasal contour restoration. Results: All patients achieved complete defect coverage with favorable aesthetic outcomes. One patient experienced flap necrosis (bilobed flap), which required secondary flap conversion, and another had wound dehiscence (nasolabial flap), which was successfully managed with secondary intention healing. No cases of long-term distortion or major donor-site morbidity were observed. Conclusion: Local flaps provide a reliable and aesthetically effective solution for nasal reconstruction after skin cancer ablation. Precise flap selection based on defect geometry and subunit involvement is key to minimizing complications and achieving optimal structural and cosmetic outcomes. Level of evidence: Level 5