HOW WE DO IT Radix nasi Transposition Flap for Medial Canthus and Nasal Sidewall Defects RODRIGO CARVALHO, MD, * DIOGO CASAL, MD, † CARLOS ZAGALO, MD, PHD, ‡ AND JOSE ´ ROSA, MD, PHD ‡ The authors have indicated no significant interest with commercial supporters. T he head and neck are preferential locations for skin cancers, 1 and when they involve dif- ferent cosmetic units, they constitute a challenge for skin surgeons. An example of this is nasal side- wall and medial canthus area. Direct repair is pos- sible for small defects, but for larger defects, local flaps or grafts are often required. In this anatomic area, the goals of reconstruction should be to obtain functional and aesthetic results, maintaining the normal concavity of the canthus with minimal distortion of the surrounding tissues. To obtain continuity of color and texture and reproduction of a natural appearance, reconstruction with a flap is frequently the first choice. The classic banner-type transposition flap 2 is a finger-shaped random-pattern cutaneous flap that makes use of areas of adjacent laxity. This flap allows for the placement of a long linear second- ary scar in a skin fold or crease or along the junction of two cosmetic units. The authors decided to create a new application for this flap, using the skin reservoir that exists in the nose root (Radix nasi) for closure of medial canthus and nasal sidewall defects—the Radix nasi trans- position flap. Upon retrospective analysis, this flap has been used successfully in six consecutive patients, with preservation of function and form. The technique and illustrative figures are included below. Technique The flap is harvested from the skin reservoir that exists in the nose root. The width of the flap is equal to the width of the defect and the length equal to the distance from the pivot point to the far edge of the defect. The flap is rotated in an arc about the pivot point between 60° and 120°, according to the defect location. The secondary defect runs parallel and hidden in the natural skin folds existing between nose root and glabella. As the flap is rotated and transposed, nose convexity naturally corrects the eventually expected protru- sion at the base of the flap. Any tissue redundancy that the rotating motion generates is carefully removed in a direction away from the pedicle of the flap such that the narrowing of the base of the flap does not compromise the blood flow. Even in cases in which larger length:width ratios are needed, vascular supply from supratrochlear artery branches is enough to maintain flap viability. The flap is sutured in place using a simple running suture with 5/0 nylon that is removed 5 to 7 days * Dermatology Department, Curry Cabral Hospital, Lisbon, Portugal; † Plastic and Reconstructive Surgery Department, Sa ˜o Jose ´ Hospital, Lisbon, Portugal; ‡ Plastic and Reconstructive Surgery Department, Portuguese Institute of Oncology, Lisbon, Portugal © 2011 by the American Society for Dermatologic Surgery, Inc.  Published by Wiley Periodicals, Inc.  ISSN: 1076-0512  Dermatol Surg 2011;37:1777–1780  DOI: 10.1111/j.1524-4725.2011.02162.x 1777