Reconstruction of a multisubunit nasal defect involving the ala, nasal sidewall, and medial cheek: A case report

A 60-year-old female with a 5-year history of infiltrating basal cell carcinoma of the left ala underwent Mohs micrographic surgery requiring seven stages for complete clearance. The resulting 3.5 × 2.5 cm defect affected the entire left ala, nasal sidewall, medial cheek, lower lateral cartilage, and inferior nasal mucosa. Reconstruction involved using a bipedicle mucosal flap for internal lining, a scaphoid cartilage graft for structural support, and a paramedian forehead flap for the overlying cutaneous coverage, followed by a series of staged refinements for optimal cosmetic and functional outcomes. This case highlights principles for multilayered nasal reconstruction emphasizing subunit planning, mucosal lining restoration, and vascularized flap coverage to achieve both airway patency and esthetic integrity.