Extending the reach of the East-West flap: a modified technique for larger paramedian nasal tip defects

Reconstruction of paramedian nasal tip defects is challenging because of the thick, adherent skin and limited tissue mobility in this region. The East-West advancement flap is a well-established reconstructive technique but has traditionally been limited to defects smaller than 1.5 cm. We describe a modification incorporating a superiorly oriented crescent-shaped extension at the base of the inferior Burow's triangle to redistribute closure tension and preserve adjacent healthy tissue. This modification extends the applicability of the flap to larger defects while maintaining simplicity. In the cases presented, the technique achieved satisfactory aesthetic outcomes without clinically apparent nasal tip distortion or other complications, representing a practical reconstructive option for selected larger paramedian nasal tip defects.

Keywords: Mohs Surgery; Surgical Flaps; Nose