Surgical Outcomes and Complications of Distal Nasal Reconstruction: A Systematic Review and Meta-Analysis

Background: Reconstruction of the distal nose represents a major surgical challenge due to the aesthetic and functional relevance of this subunit. Various techniques—including local, regional and free flaps and grafts—have been described, but high-quality evidence comparing outcomes remains limited. Methods: Following PRISMA guidelines, a systematic review was conducted using PubMed/MEDLINE, Cochrane Library, Scopus, Embase, and Google Scholar. A single-arm meta-analysis was performed to evaluate complications, revision surgeries, and aesthetic and functional outcomes. Secondary outcomes included flap necrosis, revision procedures, and airway function. Results: Forty articles were included in the qualitative synthesis and 38 in the quantitative analysis, from an initial 587. The analysis involved 1362 patients (mean age 60.6 years) undergoing distal nasal reconstruction, most commonly for malignancy. The pooled complication rate was 11%, and was highest with regional flaps (26%). Flap/graft necrosis occurred in 5% of free flaps and 2% of regional flaps, with none reported for local flaps or grafts. Revision surgery was required in 7% overall, but was greater with mixed flaps (11%), compared to graft (3%), local (1%), and regional (0%) techniques. Dermabrasion and secondary contouring were infrequent. Aesthetic outcomes were inconsistently reported, precluding meta-analysis. Conclusions: This systematic review and meta-analysis provide an overview of reconstructive options and outcomes for distal nasal defects. Local and regional flaps remain the most reliable and versatile solutions for small-to-moderate, partial-thickness defects, offering low complication and revision rates. Free flaps, while essential for extensive or full-thickness reconstructions, are associated with greater morbidity and revision burden. Standardised reporting of outcomes relative to defect size and thickness is required to guide evidence-based decisions.