Repair of a large, exposed-cartilage nasal tip defect using nasalis-based subcutaneous pedicle flaps and full-thickness skin grafting.

Large full-thickness nasal tip defects after Mohs surgery present a challenge to the reconstructive surgeon. The interpolated paramedian forehead flap is the standard modality to repair such defects, especially when exposed cartilage is present. Despite providing an excellent cosmetic outcome, some patients are reluctant to undergo this procedure due to the associated temporary deformity, the permanent forehead scar, and the need for at least two stages to achieve a successful outcome. A 62-year-old Caucasian man was referred for Mohs micrographic surgery for an infiltrative basal cell carcinoma on the nasal tip. Complete excision of the tumor required five surgical stages, resulting in a 2.3 2-cm defect through which exposed alar cartilages and upper lateral cartilages could be seen (Figure 1). How would you reconstruct this defect?