Background
Ala nasi defects can be difficult to reconstruct due to visibility, unique contour, required support and functionality. While small alar defects are often reconstructed with full thickness skin graft or chondrocutaneous grafts, larger ones often necessitate staged forehead flap. First described by Sushruta in 600 BC, it continues to be used to current day but can be bulky, multi staged and prone to donor site morbidity. A novel alternative can be use of local island inversion flap combined with glabellar, bilobed or other local flaps
Method
Case series of different combination of local flaps used for complex nasal reconstruction is presented without needing graft or forehead flap with good cosmetic and functional outcomes.
Conclusion
For large, complex nasal reconstruction use of combination of local flaps can be used successfully to reconstruct the defect. Combining island inversion flap with other local flaps can provide good cosmetic and functional outcomes as demonstrated in these case studies without the morbidities and limitations of forehead flap and can be considered as an alternative to the often used flap.