Objective: To review the literature on the principles of three-layer reconstruction for severe nasal deformity, focusing on the three tissue sources most commonly used: a supratrochlear-based paramedian forehead flap for external cover, a pedicled septal mucoperichondrial flap for lining and an autologous costal cartilage graft for the framework.
Content: The article outlines the anatomical basis and role of each reconstructive layer, compares published outcomes of each technique in international and Vietnamese series, and reviews recently described single-stage techniques. Literature was retrieved from PubMed/MEDLINE and Google Scholar in English and Vietnamese for the period 2000 to 2025.
Findings: The forehead flap remains the standard for external cover; a Vietnamese series of 48 soft-tissue nasal defects reported complete flap survival in 89.6%. The septal mucoperichondrial flap provides vascularised lining, the basis for protecting cartilage grafts from contracture, exposure and resorption. Autologous costal cartilage supplies abundant material for framework reconstruction. Series using all three layers with a septal flap remain limited to six patients with a mean follow-up of 11.5 months. Single-stage techniques published in 2024 and 2025 derive the lining from the forehead flap itself and therefore represent alternative strategies without long-term follow-up.
Conclusion: Three-layer reconstruction rests on sound anatomical and physiological principles, but clinical data on the simultaneous combination of these three specific techniques remain scarce, drawn mainly from small case series without standardised outcome instruments. Prospective studies with long-term follow-up are needed, particularly for non-oncologic deformity and in Vietnamese patients.