"Jigsaw Puzzle" Advancement Flap for Repair of a Surgical Defect Involving the Lateral Nasal Ala

A 69-year-old woman presented with a basal cell carcinoma on the left nasal ala. Closures of the lateral nasal ala are often best achieved by full-thickness skin grafting (FTSG). In cases in which the surgical defect on the nasal skin is adjacent to the cheek, cheek skin can be used as an advancement flap. This chapter describes a technique that demonstrates this principle. The cheek skin adjacent to the defect was used as an advancement flap to repair the defect. Its dog-ears are hidden in a major skin fold and a closure line between the nose and cheek cosmetic units. The advancing tissue was anchored to the deep tissue in the piriform fossa to maintain the nose-cheek contour. Despite the blunting of the alar groove, the "jigsaw advancement" as described here is indeed novel and certainly an alternative to consider in this setting, especially when repair options are limited.