DERMATOLOGIC SURGERY Horizontal advancement flap for symmetric reconstruction of small to medium-sized cutaneous defects of the lateral nasal supratip Leonard H. Goldberg, MD, FRCP, a,b and Murad Alam, MD c Houston, Texas, and Chicago, Illinois 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. (J Am Acad Dermatol 2003;49:685-9.) M ohs surgery and other types of skin cancer excision frequently culminate in full-thick- ness dermal defects of the nose. In fact, the nose is one of the most common sites for basal cell carcinoma, 1,2 and lesions on the nose may be seen even more frequently in a referral practice because of the perceived difficulty of such site-specific aes- thetic reconstructions. In recent years there has been a growing litera- ture describing flaps for correction of cutaneous nasal defects. To some extent, this derives from the increased number of small to medium-sized non- melanoma skin cancers undergoing definitive surgi- cal extirpation. Additionally, patients are more in- formed about and actively desirous of aesthetically optimal repairs. When primary closures cannot be done, local flaps provide a substrate of color and texture matched vascularized tissue that can be used to attain better cosmesis than generally possible with healing by other techniques. For instance, the dor- sum of the nose is a convex surface, where healing by second intention may be suboptimal. Because of limited local laxity, skin grafts to the nose are usually acquired from distant sites, which may provide poor texture and color match. INDICATIONS We describe a novel small flap for repair of cuta- neous defects of the lower lateral nasal sidewall, above and to either side of the nasal supratip. This From DermSurgery Associates, Houston, a the Department of Medicine (Dermatology), University of Texas, M. D. Anderson Cancer Center, b and the Section of Cutaneous and Aesthetic Surgery, Department of Dermatology, Feinberg School of Medicine, Northwestern University. c Funding sources: None. Conflicts of interest: None identified. Reprint requests: Murad Alam, MD, Department of Dermatology, 675 N Saint Clair, Suite 19-150, Chicago, IL 60611. E-mail: murad@alam.com. Copyright © 2003 by the American Academy of Dermatology, Inc. 0190-9622/2003/$30.00 + 0 doi:10.1067/S0190-9622(03)01833-4 685