Unilateral pedicled myocutaneous island flap for nasal tip reconstruction: a case series

Hugo J. Leme, Department of Dermatology, Hospital Garcia de Orta, Almada, Portugal José Ramos, Serviço de Dermatovenereologia, Unidade Local de Saúde de Almada-Seixal, Almada, Portugal António Magarreiro-Silva, Serviço de Dermatovenereologia, Unidade Local de Saúde de Almada-Seixal, Almada, Portugal Ana S. Pereira, Serviço de Dermatovenereologia, Unidade Local de Saúde de Almada-Seixal, Almada, Portugal Frederico Bonito, Serviço de Dermatovenereologia, Unidade Local de Saúde de Almada-Seixal, Almada, Portugal João Goulão, Serviço de Dermatovenereologia, ULS Almada-Seixal, Portugal Ana Filipe-Monteiro, Serviço de Dermatovenereologia, Unidade Local de Saúde de Almada-Seixal, Almada, Portugal

Objective: To describe the surgical technique, indications, and clinical outcomes of the unilateral pedicled myocutaneous island advancement flap for nasal tip reconstruction following tumor excision. Methods: A retrospective observational study was conducted, including nasal tip reconstructions performed between 2024 and 2025 using a unilateral pedicled myocutaneous island advancement flap at the Unidade Local de Saúde de Almada-Seixal. All procedures were performed under local anesthesia. Results: Five patients were included (four women and one man; mean age 63.8 years). All lesions corresponded histologically to basal cell carcinoma, and one reconstruction was performed following Mohs micrographic surgery. In all patients, the flap provided adequate mobility to close the defect without excessive tension or tip elevation. No major complications or flap loss occurred. Conclusion: The unilateral pedicled myocutaneous island flap is a reliable and versatile technique for nasal tip reconstruction, offering robust vascularity, good tissue conformity, and preservation of nasal contour. Despite its technical demands and potentially visible scar geometry, this flap is a valuable reconstructive choice for selected nasal tip defects.

Keywords: Basal cell carcinoma. Nasal reconstruction. Nasal tip. Myocutaneous island flap.