INTRODUCTION Reconstruction of the nose poses several unique problems. The contours of the nose are variable, with convex and concave surfaces in close contact with each other, and the skin texture and colour is not easy to match. The human eye easily detects the slightest variation in contour or symmetry. Nasal defects can be reconstructed with local, regional, distal or free flaps. The primary aim of reconstruction is to restore the lost function and the secondary aim is to make the reconstructed part as normal in appearance as possible. The aetiology of nasal defects is shown in Table 85.1. Essentially, the surgeon confronted with a nasal deformity has to weigh up the alternatives available and select the correct one in order to obtain the best cosmetic and functional result with the minimum donor site morbidity. The selection of method is frequently based on personal experience, known effective procedures or individual bias.1 Nevertheless, the principles laid out in this
chapter and the key points should be of use whatever the choice of technique.