Inferiorly-Hinged Transnasal Advancement Flap with Back-Cut for Medial Canthal Reconstruction: A Case Series

Abstract

The authors present variations of the inferiorly-hinged transnasal advancement flap, augmented with an inferior back-cut, as a versatile option for medial canthal defect reconstruction. A retrospective case series of seven patients with medial canthal basal cell carcinoma, all of whom underwent frozen section-controlled excision followed by immediate reconstruction using this flap technique. Surgical modifications included tailored flap sizing and use of back-cuts to enhance flap mobility. Outcomes included Strasser grading, using post-operative photographs, and complications. All defects were reconstructed successfully, with scars concealed and no major complications. Five tumours were T1a and two were staged T2b, producing defects ranging from 12 � 12 mm to 30 � 18 mm in diameter. These cases demonstrate the flap�s suitability for moderate to large defects that are not amenable to simple techniques such as primary closure. Strasser grading across six patients showed good aesthetic outcomes (scores 0�2) with no cases rated �obvious� or �deforming�. This report highlights the versatility of the inferiorly-hinged transnasal advancement flap as a first-line option for medial canthal defects. It provides excellent cosmesis particularly for moderate to large defects in patients with adequate nasal bridge laxity, a natural skin crease inferior to the glabella, and those who wear spectacles.