A new method for total nasal reconstruction. The trapezius myocutaneous island "paddle' flap.

Surgical reconstruction of the total rhinectomy defect presents unique difficulties for both the surgeon and the patient. The forehead flap provides an excellent color match and two-stage reconstruction. However, frequently, flap delay is needed, there may be insufficient cutaneous tissue available, and, most important, a secondary residual facial deformity is created. The tube abdominal flap technique of total nasal reconstruction provides adequate tissue and a hidden scar but gives a poor facial color match, offers multiple operative stages, and can severely debilitate the patient's shoulder from prolonged immobilization. This article outlines a new method of total nasal reconstruction using a trapezius myocutaneous island "paddle" flap. This flap provides abundant cutaneous tissue without need for delay, offers an excellent color match, requires a two-stage operation, and uses a hidden donor site. No immobilization is needed in the transfer of this regional flap to the face and, thus, would be of particular usefulness in the geriatric patient.