Answer:
Shaw (Clinics of Plastic Surgery 1981; 8:471) reviewed donor site options for microvascular reconstruction of the nose. Free tissue transfers to the nose are limited by the requirements of color match, size, and thickness. The size of a suitable flap for nasal reconstruction (7 x 9 cm) often makes it too large for many head & neck donor sites and too small for other areas such as the latissimus dorsi and rectus abdominus. Normal nasal skin is also only about 2-4 mm thick and hairless, restricting further the number of possible donor sites.
The radial forearm flap without bone was described by Yang & Xia in China twenty years ago and more recently with a bone component by Kobayashi et al (1995) in Japan. Kobayashi included a radial bone osteotomy which is formed to make an L-shape bone flap.
The dorsalis pedis flap with the second metatarsal can be transferred with the pedicle anastomosed to the facial, labial, or superficial temporal artery. Turndown flaps recreate the inner nasal lining and the second metatarsal acts as a dorsal strut. According to McCarthy this is the most popular option for free tissue transfer.
Forehead flaps based on the anterior branch of the superficial temporal artery have been reported to provide good color match and thickness. The donor defect is conspicuous and the superficial temporal vessels can be quite small and fragile, making the procedure technically more demanding.
A retroauricular flap based on the posterior auricular vessel is thin and pliable but the color has been reported to be noticeably different and the flap size is often limited. The vessels are also small, often less than 1 mm in diameter.
The transverse cervical artery flap has been reported to have an ideal color match with a large vessel for anastomosis but the thickness of the flap (up to 1.5 cm) may make secondary debulking procedures necessary.
A flap based on the thoracoacromial vessels likewise tends to give good color match with large vessels for anastomosis, but its thickness also may make secondary debulking procedures necessary.