One-Stage Nasal Reconstruction with Full-Thickness Composite Posterior Auricular Artery Perforator Free Flap

Abstract

INTRODUCTION: Although there are diverse methods of reconstruction of large full thickness defects of the nasal region including zones II and III, these methods require the patients to undergo stepwise operations and thus these methods cannot be used when the patients cannot be followed up.1 In this respect, authors are to report a one-stage reconstruction method for nasal composite tissue defects using full-thickness composite posterior auricular artery perforator free flaps. METHODS: A 25-year-old male patient presented with a nasal composite tissue defect due to a human bite without amputee (Figure 1). He was a foreigner and could not be followed up after he would leave the country three months later. In this respect, the defective nasal region was reconstructed using a one stage full-thickness composite posterior auricular artery perforator flap. The wedge shaped defective region was around 2.5x2.5cm in size. The nasal lining defect was around 0.5x1cm in size. Unlike flaps that had been reported earlier, full-thickness composite tissues were harvested including the conchal skin to include both the conchal cartilage and the posterior auricular skin. The flap was inset so that the conchal skin would become the nasal lining, the conchal cartilage would become the alar cartilage and the posterior auricular skin would become the external skin. The recipient vessel was the lateral nasal artery and since no vein was connected, systemic heparinization was used to perform a salvation of the flap. The donor site was primarily closed.Figure 1: Initial presentation of the patient.RESULTS: The flap and the donor site were maintained well without any particular events postoperatively. Based on the CT taken at 20 days after the surgery, the conchal cartilage of the flap was identified as being maintained well. Silicone sheeting was performed from six weeks after the surgery and an appropriate nasal contour maintained in situ was identified at 10 months (Figure 2). The donor site showed a minor difference in the auriculocephalic angle except for slight narrowing of the intertragic notch.Figure 2: Postoperative 10-month view of the patient.CONCLUSION: The posterior auricular artery perforator flap using the full-thickness tissues of the ear can be used in one-stage reconstruction of nasal composite defects and showed satisfactory results. This is considered to be another good alternative for existing nasal region reconstruction methods that require multiple stages.