Reconstructive surgery in nasal pyramid can be a challenge for surgeons. Moreover this anatomic area is one the most common sites for non-melanoma skin cancer.

The “puzzle” flap was described to repair surgical defects located just on the nasal ala affecting melolabial sulcus. We have seen this flap can be also very useful to repair defects located on nasal sidewall and cheek without dysfunctional effects and with a good cosmetic result.