Medium and large nasal defects are mostly addressed with paramedian forehead flap reconstruction.

The superior extended nasal myocutaneous island (SENMI) flap offers an alternative that can be single stage and can avoid a gross deformity.

To describe a new flap for nasal reconstruction of medium and large nasal defects and to define the flap's limitations and indications.

This original study was a retrospective case series of patients who underwent SENMI flap reconstruction from 2008 to 2018 at a private tertiary referral center—Skin Cancer and Reconstructive Surgery Center (SCARS Center).

Participants included all consecutive patients of the senior author who had undergone SENMI flap from September 2012 to December 2018, consisting of 53 patients.

Indications for surgery were mostly skin cancer defects, postreconstructive, and post-traumatic deformities. IRB approval was obtained from the St. Joseph Health Center for Clinical Research.