DS13 Subcutaneous-only pedicle ‘hinge’ flaps for nasal defects: experience from a UK Mohs unit

Abstract

A subcutaneous-only pedicle flap, the ‘subcutaneous hinge flap’, is an island of adipose tissue with or without muscle. It is often harvested from the cheek but can move into a nasal defect in a hinge motion, like ‘turning a page in a book’, thus restoring bulk for deep soft-tissue loss. It acts as a vascular bed for a full-thickness skin graft (FTSG) and can maintain contour at the nasofacial sulcus. It is a quick and simple technique with the advantage of completing a one-stage procedure, over alternative repairs. In this study we investigated the real-world utility of subcutaneous hinge flaps with or without FTSG for nasal sidewall, ala and dorsum defects, in a UK Mohs unit. In a prospective case series (2025–26) of at least eight cases we assessed the utility of subcutaneous hinge pedicle flaps with or without FTSG in the reconstruction of defects after Mohs micrographic surgery. The average procedure duration was 13 min. The patients were aged 41–83 years. The subcutaneous ‘hinge’ flap or transposition flap was used predominantly at the nasal ala and nasal tip for reconstruction of postoperative Mohs defects measuring up to 2 cm. All cases had a FTSG combined with a subcutaneous-only pedicle flap. The hinge flap can also be performed solely without an FTSG, as supported by the literature. Patient satisfaction with cosmesis at 3 months was assessed using a 10-point Likert scale (from 0, not satisfied to 10, extremely satisfied), with a mean score of 8 out of 10 at 3 months. Good contour restoration was achieved for deep nasal defects without excessive bulk. A subcutaneous hinge flap is quick and easy to perform, involving minimal incisions, which can be hidden easily within subunit boundaries. It achieves excellent contour and avoids tension on surrounding structures and free margins. There is variable survival of the overlying FTSG but the hinge flap alone is viable. Aesthetic outcomes appear good, and there is no functional impairment compared with other procedures, such as a compromised nasal valve with nasolabial transposition flaps.