Free temporoparietal fascial flaps and full-thickness skin grafts in aesthetic restoration of the nose

Free tissue transfers have been rapidly replacing distant flaps for use in nasal reconstruction. The temporoparietal fascial flap is a thin, broad, pliable, and well-vascularized flap. It can be used to drape over the cartilaginous and bony framework of the nasal skeleton and nourish the underlying primary cartilage grafts as well as the overlying full-thickness skin graft. The thin contour of the flap is aesthetically superior to thicker skin flaps and eliminates the need for secondary defatting or touch-up procedures. A large, single sheet of full-thickness skin graft, harvested from the supraclavicular region, can be applied over the fascial flap in the same session and provide a quite acceptable color match. The authors present a case whose alar margins and atrophic nasal skin were restored in one session by primary conchal cartilage grafts, a free temporoparietal fascial flap, and a full-thickness supraclavicular skin graft.