Comparison between free flap and local flap in post-oncological nasal reconstruction

Post-oncological nasal reconstruction is one of the greatest challenges in facial reconstructive surgery, due to the anatomical complexity of the nose, its essential respiratory function, and its central role in facial identity.Among the available strategies, local flaps and free flaps represent fundamental approaches, with distinct indications and complementary results.This article provides a detailed comparison between local flaps and free flaps in nasal reconstruction after oncological resections, exploring anatomical principles, reconstructive planning, surgical techniques, aesthetic and functional results, complication rates, donor site morbidity, psychosocial impact, and clinical decision algorithms.The analysis shows that local flaps remain the basis of nasal reconstruction for small and moderate defects, while free flaps are indispensable in extensive defects, full-thickness defects, and irradiated or previously operated fields.The appropriate choice of technique, based on classic reconstructive principles and patient individualization, is crucial for lasting and satisfactory results.