DS10: The spiralled Reiger flap: a novel approach to the reconstruction of challenging defects of the distal nose: lessons learned from 44 cases

Hayley Smith and Walayat Hussain

Leeds Teaching Hospitals, Leeds, UK

The aesthetic repair of surgical defects of the lower lateral nose is challenging for the dermatological surgeon. The aims of any reconstructive approach at this aesthetically sensitive site should be to optimize tissue match and volume replacement; to conceal incision lines within naturally occurring skin creases and/or at the junction of cosmetic units; to ensure nasal symmetry is preserved; to maintain adequate air flow by preserving patency of the nasal vestibular aperture; and to ensure the nose–cheek junction is not effaced. The single-stage Reiger flap (dorsal-nasal rotation) is well established in the reconstructive literature for resurfacing medium-to-large-sized (primarily vertically orientated) defects of the nose but may readily induce nasal asymmetry and create tension along the cheek–nose junction. However, in carefully selected patients with sufficient nasal root laxity, the introduction of a novel spiralling motion of the flap enables the aesthetic, tension-free closure of such defects with favourable outcomes. To date, we have performed the spiralled Reiger flap (SRF) in 44 cases (24 males and 20 females, median age 63 years). The average defect size was 1·4 × 1·7 cm. There have been no cases of distal flap necrosis and all patients have self-reported their outcome with the SRF as either good or excellent. A single case required a nasal tip revision procedure to address excessive fullness of the distal nose that failed to settle with intralesional steroid injection and regular scar massage. We present our experience of the SRF in the largest case series to date, and discuss nuances in flap design and execution that enable the aesthetic repair of challenging defects of the distal nose.