Objective: The purpose of this poster is to review our experience in nasal reconstruction, and present our choices to repair lining, skeletal framework and skin cover. A retrospective study evaluates the techniques, comparing the results obtained. Material and Methods: From 1989 to 2002, 117 patients (pts) with nasal defects were treated. The reconstruction was consecutive to oncologic resection in 102 pts and post-traumatic in the remaining 15 pts . In order to choose the ideal flap, different items were considered: texture, color match, thickness, proximity, adequate pedicle, number of surgical steps and the chance to perform another flap. Results: After the first description by Gonzalez-Ulloa and Stevens, redefined by Millard, and especially by Burget who focused on esthetic subunits, the importance of light reflection and placing the scars over hidden locations, nasal reconstruction aimed at the gold standard. But sometimes, the actinic damage in elderly patients increases the risk of local complications, and we should consider a less extensive surgery. We divided the reconstruction in 6 areas: dorsum, lateral wall, tip, nasal ala, soft triangle and columella. Different techniques were used considering the size of the defect The flaps used were: Axial Frontonasal (Marchac) =25, Random Frontonasal (Cronin) = 18, Island (V-Y closure) dorsum = 9, Island (V-Y closure) lateral wall= 17, Nasolabial = 13, Paramedian Forehead = 7, Scalping =2.The series includes 6 composite grafts and 20 direct closures. In this series, reconstruction of the dorsum of the nose based on the Rieger flap, like our Cronin modified flap or Marchac flap are considered and we discuss the results obtained. Basically, most of the flaps designed to cover skin defects of the tip may be used in dorsum defects. The Marchac flap (axial pattern) and the Cronin (random pattern) may be used with a narrow pedicle. In cases of lateral wall defects we discuss which pedicle to use: homo or contralateral. The difference between these flaps is that Marchac designed an axial pattern flap which may be transferred either with a narrow bridge even as an island if necessary. But according to Vanderput the dorsum of the nose has a fine anastomotic plexus between the dorsal nasal artery and the angular branch of the facial artery. We believe that the vascularization of the dorsum is rich enough to allow safe flaps. Small necrosis of the tip of these flaps has occurred in 8.9% of cases, but most of them in damaged skin. Many patients (52%) complained of a residual flap edema (3 months) but the late postoperative result(6 months)was satisfactory. We discuss other techniques according to the size of the defect. In cases of a total coverage of the nose we prefer the paramedian forehead flap as first choice. Finally, when should we use a skin graft, local flap or regional flap? It depends on the wound, the desired result, the age, local and general conditions and individual patient acceptance of the procedure. Conclusions: We present a retrospective series of 117 patients treated during a 13-year period, considering our choices with a large number of techniques. We prefer to perform reconstructions of esthetic units, but in some cases due to local or general conditions of the patients, we must consider a less extensive surgery. We focused on the reconstruction of the dorsum of the nose, and consider the axial fronto-nasal flap a good choice.

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