Dorsal Nasal Flap Research Articles

Split Dorsal Nasal Flap: A Modification to Expand Its Utilization.

Nasal reconstruction presents the facial plastic surgeon with a complex problem given its functional and aesthetic importance. The dorsal nasal flap is a composite rotational flap of the glabella and nasal dorsum that can be used for nasal dorsum and tip defects of medium to large sizes. Given its composite nature, this flap can be split into its constituent parts-the epidermis and dermis and the subcutaneous tissue and superficial musculoaponeurotic system-without flap loss. This case series describes this technique and various potential applications within nasal reconstruction.

Nasal Dorsum Rotation-Transposition Flap Associated with Guitar-String Sutures: One-Stage Reconstruction of Large Defects on the Nose.

(1) Background: The preferred reconstructive option for closing small- or medium-sized defects of the distal half of the nose is the use of local flaps. The dorsal nasal (Rieger) flap is suitable for closing medium-sized defects at this location, especially when they are medially located, and are wider rather than tall. We describe a rotation-transposition dorsal nasal flap reconstruction for large nasal defects. The novelty of this design includes the addition of a small transposition lobe to the rotation flap, enabling the acquisition of tissue from either the lateral sidewall or the nasolabial sulcus, facilitating closure with guitar-string sutures. (2) Methods: We conducted a retrospective chart review of all the patients with large defects (>20 mm) of the nose who underwent nasal dorsum rotation-transposition flap repair between January 2019 and November 2022 at a single academic center. (3) Results: Fourteen patients (eight males, six females; ages 47-83, mean age 60 years) with defects (range: 20.00-35.00 mm) on the dorsum and nasal tip were recruited. Follow-up duration ranged from 12 months to 3 years, with all cases showing good or excellent oncologic and cosmetic results. (4) Conclusions: The rotation-transposition dorsal nasal flap was demonstrated to be a reproducible one-stage technique for large defects of the dorsum and nasal tip, with minimal risk of aesthetic or functional complications. Guitar-string sutures allowed the reduction of the defect size, facilitating a smaller flap design.

The Versatility of Expanded Applications of the Dorsal Nasal Flap in Nasal Reconstruction

The Versatility of Expanded Applications of the Dorsal Nasal Flap in Nasal Reconstruction

The versatility of expanded applications of the dorsal nasal flap in nasal reconstruction

The versatility of expanded applications of the dorsal nasal flap in nasal reconstruction

Basal cell carcinoma excision with bilobed flap nasal reconstruction

: Basal cell carcinoma (BCC) is a slow growing, locally destructive, malignant tumor of the skin. It is derived from non- keratinizing cells that originate from the basal layer of the epidermis. After excision nasolabial flap, median forehead dorsal nasal flap, glabellar flaps, bilobed flaps, cheek and craniofacial flaps are used for nasal reconstruction. The Zitelli’s bilobed flap is one of the most useful flaps for nasal reconstruction. It is a simple double transposition flap and is designed to move more skin, without deformation. A 60-years old male patient reported to our department with complains of circular raised and reddish discoloration lesion on the left side of the nose. Surgical excision and reconstruction of defect using bilobed flap was planned under general anaesthesia. The flap was designed in such a manner that the flap could be turned over the defect on the ala of the nose and closure of the donor site could be done primarily without deformity. Surgical excision of the nose lesion was done and reconstruction was performed using bilobed flap. The patient has been followed up for 1year with no evidence of recurrence. The bilobed flap is a versatile and reliable flap for coverage of small skin and soft tissue defects of the lower third of the nose. It gives a successful outcome if it is designed well and performed properly. In this case it helped us to achieve a defect free cosmetically fine nose after excision of basal cell carcinoma nose.

Evaluation of Modified Dorsonasal Flap for Reconstruction of Dorsonasal Defect in Erbil

Background and objectives: nasal reconstruction is challenging for plastic surgeons mainly because its midfacial location and the relationship between convexities and concavities of nasal subunits that make it difficult to hide any contour deformity; as a result, proper planning of final scar location is crucial for successful aesthetic outcome. The modified dorsal nasal flap is used for resurfacing nasal tip defects with respecting of these nasal subunits. This paper evaluates the outcome of modified dorsonasal flap for reconstruction of the dorsal nasal defects. Method: in our department twenty nasal defects were reconstructed with modified dorsal nasal flap between years (2016-2019); Charts of these patients were analyzed in relation to their age, cause and size of the defect, complications and appearance. Results: half of patients who underwent nasal reconstruction by dorsal nasal flap were males (n=10) and the other half were females (n=10), mean age 39.5 months, median defect diameter was (21mm), follow up period ranged from (7-42 months), all patients were satisfied with results with no significant complications including: hematoma, infection, flap loss or wound dehiscence. Conclusion: Dorsal nasal flap is reproducible one stage flap for reconstruction of nasal defects with minimal complication and good aesthetic outcome.

Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap.

Nasal reconstruction is one of the most challenging procedures in plastic surgery. To get optimal aesthetic and functional results, the surgeon should know all the options well. Forehead flap is the gold standard technique for closure of medium to large defects of the nose. Although it provides a very good color and texture match, it may become a difficult option in patients with poor condition. The aim of this study was to define a simpler technique for nasal reconstruction using combined local flaps.Twelve patients, operated using a dorsal nasal flap combined with a nasolabial perforator propeller flap, were presented in the study. Properties of the patients, defect size and locations, and complications were evaluated.The mean size of the reconstructed defects was 10.1 cm2. No flap loss was observed. Venous congestion was the most common complication and resolved spontaneously in all cases. Two cases had partial distal necrosis, which also healed spontaneously.Closure was achieved successfully in all cases with a medium to large nasal defect using a combined dorsal nasal flap and nasolabial perforator propeller flap. This method can be used as an alternative to forehead flap.

Invited Discussion: Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap (SCS-20-02336).

Invited Discussion: Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap (SCS-20-02336).

Nasal Hump Reduction may Improve Dorsal Nasal (Rintala) Flap

Nasal Hump Reduction may Improve Dorsal Nasal (Rintala) Flap

Unilateral or bilateral freestyle infra-orbital perforator flap in reconstruction of external soft tissue nasal defects

Nasal reconstruction is one of the most challenging procedures for plastic surgeons, and whether it should be performed using the subunit principle versus the defect-only principle remains a matter of debate. Skin grafting and local flaps such as dorsal nasal, bi-lobed, V-Y advancement, glabellar, nasolabial, forehead, and para-median forehead flaps have been used in nasal reconstruction. Another style of flap that has also been used for nasal reconstruction is the perforator flap. In this work, we will evaluate the utility of unilateral or bilateral freestyle infra-orbital perforator flaps in the reconstruction of nasal skin defects. This prospective clinical study was conducted in the plastic surgery department of Tanta University Hospital, Egypt, between February 2015 and April 2019. A total of 34 patients who presented with nasal skin tumours that did not invade the nasal bones or cartilage were ultimately enrolled in the study. The age of the patients ranged from 43 to 78 years, with a mean of 53 years. Clinical assessment was performed by three plastic surgeons who did not share in this study using a four-point scale. The assessment indicated excellent results in 22 (64.7%) patients, good results in 7 (20.6%) patients, fair results in 5 (14.7%) patients, and no poor results. No significant complications were observed in our experience. We believe that unilateral and bilateral infra-orbital perforator flaps may provide an alternative reconstruction method for different nasal defects. Level of Evidence: Level IV; therapeutic study.

Reconstruction of dorsum of nose after excision of basal cell carcinoma

<p>Basal cell carcinoma, squamous cell carcinoma and melanoma are the most common malignant tumors of the face. The paramedian forehead flap is the standard reconstructive choice for closing large-sized defects of the distal half of the nose. A melolabial interpolation flap and bilobed or trilobed flaps are another option. The dorsal nasal (Rieger) flap is suitable at this location for the closure of small-sized defects, particularly when they are located medially. Here we are discussing an ulcus rodens case we observed in an elderly patient which was treated with a Rieger’s flap.</p>

Le lambeau de Rieger-Marchac : complications et satisfaction des patients

Like all surgical procedures, dorsal nasal flaps may be followed by both early and late complications. The aim of this study was to evaluate the surgical complications and cosmetic outcome of dorsal nasal flaps over a 7-year period in an academic dermatologic surgery unit. Data were collected retrospectively for all patients undergoing dorsal nasal flap between 1 January 2006 and 31 December 2013. Early and late complications were recorded. Patients were contacted by phone to assess long-term outcomes. A total of 35 patients were included. Early complications included bleeding (n=2), local infection (n=2) and focal flap necrosis (n=1). Late complications comprised flap thickening (n=7), restriction of the medial canthus (n=2), opening of the labionasal angle (n=1), stitch granuloma (n=1) and telangiectasia on the flap (n=1). Regarding the aesthetic result, seven patients were very satisfied with the flap. Four patients underwent corrective surgery and one patient had laser treatment for telangiectasia on the flap. Two thirds of patients were satisfied with the aesthetic results and one third had late complications of the flap. Consequently, patients undergoing Rieger-Marchac procedures must be informed of the potential need for further corrective measures following nasal dorsal flap repair.

Lavage With Lidocaine and Adrenaline Mixture Reduces the Early Side Effects of Septorhinoplasty.

Pain, ecchymosis, and edema are well-known temporary consequences of septorhinoplasty procedure. They give rise to patient's complaints, discomfort, and dissatisfaction, increasing the patient's anxiety and recovery time in the early postoperative course. Several approaches have been described to reduce the level of these complaints.The aim of this clinical study was to determine the effect of nasal lavage with lidocaine and adrenaline mixture on early postoperative levels of pain, edema, and ecchymosis in 24 hours after a septorhinoplasty procedure. This study included 40 consecutive patients who underwent septorhinoplasty procedure in which nasal septum was entirely dissected and corrected. Patients were randomly divided into 2 groups of 20 patients. At the end of the operation, incisions were closed with sutures, and both blood and seroma collections beneath the flaps were sufficiently drained by means of finger pressure, and then in patients of group A (control group), 5 mL of saline solution was given under the dorsal nasal flap to make lavage and in patients of group B (study group), 5 mL of 2% lidocaine with 1:100,000 adrenaline was given to the area under the dorsal nasal flaps. Five minutes later, nasal package and splint were applied and the operation was finished.Patients were evaluated for the level of pain sensation, degree of periorbital edema, and ecchymosis at the 1st, 3rd, 6th, 12th, and 24th hours postoperatively. Overall satisfaction scores were also determined at the 24th hour. A total of 40 patients (19 males and 21 females) between 18 and 42 years of age with a mean ± standard deviation of 24.5 ± 4.52 years were included in the study. Statistically significant differences were found between the A and B groups with regard to early postoperative pain, edema, ecchymosis, analgesic use, and satisfaction scores, suggesting the effectivity of the lavage with lidocaine-adrenaline mixture on the early postoperative pain, edema, and ecchymosis relief. Lavage of nasal flaps with lidocaine-adrenaline mixture seems an effective and simple way in the control of early postoperative pain, edema, and ecchymosis in septorhinoplasty patients. In addition, it considerably reduces total analgesic consumption and patients' discomfort, leading to high level of satisfaction.

Elongated Dorsal Nasal Flap to Reconstruct Large Defects of the Nose.

The typical reconstructive option for closing large-sized defects of the distal half of the nose is the paramedian forehead flap. Other alternatives are a melolabial interpolation flap and bilobed or trilobed flaps. The dorsal nasal (Rieger) flap is suitable for closing small-sized defects at this location, especially when they are medially located. The authors describe a modified dorsal nasal flap reconstruction for large nasal defects. The novelty of this study lies in lengthening the leading edge of flap rotation, which may provide tissue either from the adjacent nasal skin, the nasofacial groove, or the cheek. The authors performed a retrospective chart review of all patients with large defects (>20 mm) of the nose who underwent modified dorsal nasal flap repair between January 2004 and March 2015 at a single academic center. Twenty-seven patients (16 male, 11 female; ages 44-88, mean age 62 years) had defects (the smallest 15 × 21 mm, and the largest 32 × 37 mm) on the lower portion of the nasal pyramid. Follow-up ranged from 12 months to 11 years with good or excellent results in all cases. Elongated dorsal nasal flap is a reproducible one-stage flap for large defects of the nose, with minimal risk of aesthetic or functional complications.

Reconstruction with Dorsal Nasal Flap after Excision of Basal Cell Carcinoma of the Nose.

Reconstruction with Dorsal Nasal Flap after Excision of Basal Cell Carcinoma of the Nose.

Trilobed flaps: an alternative to dorsal nasal flaps

Trilobed flaps: an alternative to dorsal nasal flaps

Beyond Rieger's original indication; the dorsal nasal flap revisited

IntroductionFew reconstructive options are available for nasal defects measuring >2 cm. Staged procedures are often utilized for nasal defect reconstruction, but they are not feasible in some patients. MethodsOut of 92 patients operated upon for nasal skin lesions between 2009 and 2011, patients who received reconstructive surgery with a dorsal nasal flap, nasal skin lesions located in lower half of nose (≤5 mm from the alar rim), defect diameter ≥3 cm were included in this study. ResultsPatients with nasal lesions larger than 3 cm who refused a staged procedure and were prone to compromised follow up underwent dorsal nasal flap reconstruction. Clear margins were obtained and no flap loss occurred. Minor complications occurred, such as flap dehiscence. ConclusionThe dorsal nasal flap can be effectively utilized for selected lesions as a surrogate for staged procedures that use various local flaps, such as the paramedian flap.

Prolonged dorsal nasal flap with superiorly based nasolabial flap for large nasal tip defects: One-stage reconstruction

Prolonged dorsal nasal flap with superiorly based nasolabial flap for large nasal tip defects: One-stage reconstruction

Morphologic variations of sesamoid cartilages of the nose in Iranian cadavers

Accessory cartilages are small nasal cartilages between the lateral crus and piriform aperture of the nose bilaterally. These cartilages are among the supporting structures of the nasal tip. This prospective cross-sectional study was conducted on Iranian fresh cadavers for evaluation of ethnic differences. Seventy-two sesamoid cartilages in 41 cadavers (mean age 42 years) were dissected to evaluate anatomy and anthropometry of the sesamoid cartilages. Elevation of the dorsal nasal flap after a collumellar incision was done. After the separation of the lower lateral cartilages and sesamoid cartilages on each side, the anatomy and anthropometry of the cartilages were assessed. In 12% (5) of the cadavers there were no sesamoid cartilages, and in 88% (36) of the cadavers there was 1 sesamoid on each side. The shape of the sesamoid cartilages was rectangular in 66% (27) and triangular in 22% (9). The mean length, width, and thickness were 3 mm, 2 mm, and 0.75 mm, respectively. This cartilage was single on each side of the nose and its shape was an irregular rectangle or triangle and has an important role in preserving nasal alar contour and tip projection. These findings confirm ethnic variations in the sesamoid nasal cartilages when this Iranian population is compared with other populations assessed in earlier reports.

Distally Based Dorsal Nasal Flap in Nasal Ala Reconstruction

The nasal dorsum is a good skin flap donor site for alar reconstructions because of its qualities: appropriate color, texture, and thickness. An anatomic vascular study on cadaver and the clinical use of the dorsal nasal skin flap, inferiorly based on the nasal septal branches, is reported. Vascular anatomy of the nasal dorsum was demonstrated in five fresh-frozen latex-injected heads. Fourteen patients were operated of reconstruction of the nasal ala using an inferiorly based dorsal nasal flap. Nasal septal branches, from the superior labial arteries, give vascular supply to the nasal tip. Connections of these arteries with lateral nasal branches (facial system) and dorsal nasal arteries (ophthalmic system) form a consistent vascular network in the dorsal nasal superficial muscular aponeurotic system and allow to safely raise cutaneous flaps distally based. No total or partial loss of the flaps was observed in clinical use. The donor site was sutured directly in 13 patients and with a skin graft in one. The inferiorly based dorsal nasal flap provides very good cosmetic and functional results and could be considered an additional adequate surgical option for nasal ala reconstruction, especially when skin from the nasolabial fold, upper lip, and cheek is not available. The authors have indicated no significant interest with commercial supporters.