Revision Rhinoplasty and Frontal Prefabricated Island Flap in Partial Nasal Reconstruction

Abstract

Frequent late complications in partial nasal reconstructions are pinched nose and alar collapse. Both are managed by extra-mucosal dissection of the lining in the upper and lower lateral cartilage area and by supporting the alae with cartilage or composite grafts. For surgical management of septal perforation up to 4 cm in diameter, the mucoperichondrium and the mucoperiosteum are dissected like a sleeve, facilitating suture of the perforation in both flaps. The procedure ends with the interposition of a dryed sheet of parietal fascia. For perforations larger than 4 cm in diameter, I advocate a three-stage procedure with a spoon-shaped compound buccal flap. At the present time, the flaps I prefer are the compound forehead island flap, the frontotemporal flap, the fronto-parieto-postauricular occipital flap, and the oblique forehead flap. The frontotemporal and the compound island flap are already modeled as much as possible at the donor area using skin, mucosa, and cartilage grafts for prefabrication of the structures of tip alae and columella before transfer to the defect.