DS23 Nasal columellar advancement flap with a twist

Abstract An 85-year-old man underwent Mohs micrographic surgery (MMS) for a 5 × 4-mm basal cell carcinoma on the left nasal tip. Tumour clearance was achieved after two stages of MMS with a defect measuring 10 × 9 mm, with depth to subcutaneous fat. Repair options were discussed, and the patient opted for flap repair. We considered a columellar advancement flap as the defect was distally located, small and shallow, and had dimensions taller than wide. The flap was elevated down to the perichondrium and the flap was secured with 5-0 Monocryl and 6-0 Vicryl Rapide. No postoperative complications were reported. At the 1-month follow-up, the wound had healed completely and the patient was very satisfied with the functional and cosmetic outcomes. The existing literature on the use of the columellar advancement flap advocates that this is used strictly for midline nasal tip defects. In our case, we performed this flap with a small degree of rotation and this has healed without complication. Furthermore, it can improve nasal tip ptosis. However, due to the limited pedicle size, there is the potential for compromise to blood supply, and as such careful patient selection is essential. This is a useful flap to consider within the repertoire of nasal tip reconstruction and has a limited surgical footprint.