Background: Aesthetic repair of small cutaneous defects of the nose is a common challenge for the dermatologic surgeon because nonmelanoma cancers occur frequently in this location. Objective: Our aim was to devise a simple flap for repair of small to medium-sized defects of the lateral nasal supratip. Methods: The mechanics of the proposed horizontal advancement ("east-west") flap are described. Patient selection, flap design, and flap mechanics are discussed. The benefits and limitations of this repair are compared with those of alternative closures. Results: The horizontal-advancement flap is an easily visualized, constructed, and executed flap that permits repair of small to moderately sized lateral nasal supratip defects without inducing asymmetry of the nasal architecture. The flap is well camouflaged in skin lines, the ala and nares are not distorted, and the large, untwisted pedicle contributes to flap viability. Large defects and defects far lateral to the midline may not be amenable to this repair. Conclusions: In selected patients with small to medium-sized lateral nasal supratip defects, the horizontal advancement flap is a simple, reliable, and aesthetically pleasing reconstruction option.
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