Special thanks to Dr. Chris Kandl, MD for his invaluable help with particular case

Key Concepts:

1. Use nondominant hand. Check Allen sign for hand vessel adequacy
2. Radial skin flap will be used for intranasal mucosal lining. Distal end will become the intranasal portion along the upper 2/3 (nasal bone & ULC) while more proximal skin becomes lower 1/3 (LLC & Septum)
3. Do not take more than 50% of radius width
4. Radial Vessel must be left connected to the radius bone for blood supply
5. After radial bone harvested, check with hand surgery to see if it should be plated.  Most of the time, it will require wrist plating with fibula bone graft.  In this particular case, that was not needed but this is a rare exception to this rule.

Distal Radial Skin becomes upper 2/3 intranasal lining (Nasal bone & upper lateral cartilage). 

Proximal Radial Skin becomes lower 1/3 intranasal lining (Lower lateral cartilage & Anterior septum)