Introduction: The paramedian forehead flap has been used for centuries in nasal reconstruction. It is a unique flap in terms of restoring complex nasal defects. It can adequately restore contour, texture, projection of the nasal tip and convexity of the ala, especially when combined with cartilage grafting. Objectives: To evaluate the versatility of the paramedian forehead flap in nasal reconstruction following Mohs micrographic surgery, especially in an outpatient setting and under local anesthesia. Furthermore, to discuss traditional approaches versus more recent refinements on its design and execution. Methods: Retrospective study of patients with surgical defects resulting from Mohs micrographic surgery that have been repaired using the paramedian forehead flap. Results: Nineteen patients were included in the study. Restoration or the nasal mucosa was required for full thickness defects in 4 (22%) patients. Structural support provided by auricular cartilage graft was required in 12 (67%) patients. The flap pedicle was designed ipsilaterally to the defect in 14 (74%) patients. Complications were minimal and unusual. Conclusions: The paramedian forehead flap is a valuable technique in the repair of extensive and deep nasal defects following Mohs micrographic surgery. With proper surgical planning, adequate measures for patient comfort, and meticulous technique, the paramedian forehead flap can be safely performed in an outpatient setting, achieving unique results in nasal reconstruction.

Keywords: MOHS SURGERY; SURGICAL FLAPS; NOSE NEOPLASMS.

Introduction: The nasolabial interpolation flap is an essential flap in nasal reconstruction. Its main indications are deep and extensive defects of the nasal ala. Objectives: To evaluate the usefulness of the nasolabial fold interpolation flap for alar reconstruction after Mohs micrographic surgery-especially in an outpatient setting and under local anesthesia-as well as to discuss refinements in its design and execution. Methods: Retrospective study of patients with nasal ala defects resulting from Mohs micrographic surgery repaired with nasolabial interpolation flap. Results: Eighteen patients were included in the study; 7 (39%) had localized defects in the ala only and were reconstructed with an isolated nasolabial interpolation flap; however 11 (61%) had defects involving both the ala and some adjacent anatomical subunit. These patients underwent a combined reconstruction. Resection of the remaining portion of a subunit was performed in 14 (78%) cases. There were no complications or recurrence after an average follow up of 29 months. Excellent functional and aesthetic results were achieved in all patients. Conclusions: The nasolabial interpolation flap is essential in the reconstruction of alar defects after Mohs micrographic surgery. If adjacent subunits are involved-such as the medial cheek or nasal sidewall-the nasolabial interpolation flap must be combined with another method of repair. The flap can be safely performed in an outpatient setting.

Keywords: MOHS SURGERY; SURGICAL FLAPS; NOSE NEOPLASMS.