Flap For Nasal Reconstruction Research Articles

A prospective study of psychological adjustment during and after forehead flap nasal reconstruction

The psychological effects of staged nasal reconstruction with a forehead flap were prospectively investigated.Thirty-three patients underwent nasal reconstruction with forehead flaps between March 2017 and July 2020. Three questionnaires were used to assess psychosocial functioning before surgery (time 1), 1 week after forehead flap transfer (time 2), 1 week after forehead flap division (time 3), and after refinement procedures (time 4). The patients were categorized into three groups according to the severity of nasal defects. Between- and within-group comparisons were conducted.All patients reported increased satisfaction with their appearance during nasal reconstruction. For most patients, levels of distress and social avoidance were highest before reconstruction (time 1). Both levels decreased as reconstruction advanced, and were significantly improved by times 3 and 4. The stage of reconstruction had a greater effect on these levels than did severity of nasal defect.Nasal reconstruction with forehead flap is beneficial physically and psychologically. Psychological evaluation before and after surgery facilitates patient–surgeon interactions and further enhances outcomes.

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

Repair of Asian nasal subunit defects using nasolabial perforator flaps: A retrospective study.

The application of nasolabial perforator flap for nasal reconstruction has been reported previously with satisfactory outcomes, but the outcomes and risk factors of postoperative adverse events have been unclear to plastic surgeons. To statistically analyze the effectiveness of the nasolabial perforator flap in nasal reconstruction and the risk factor of postoperative complications and re-operation. This retrospective study evaluated 58 Chinese patients who underwent nasal reconstruction with the nasolabial perforator flap from 2009 to 2021. The esthetic and blood supply outcomes were measured by plastic surgeons on a 5-point Likert scale. Binary logistic regression was used to determine the risk factors associated with postoperative complications and re-operation. The mean age of the cohort was 66.4 ± 2.0 years. The defect size ranged from 6.5 × 5.5 mm2 to 40 × 70 mm2 , and 48.3% of defects covered more than one nasal subunit. Venous congestion occurred in 4.9% of flaps, and the immediate overall postoperative score was 7.72/10. More than one nasal subunit of involvement was the risk factor associated with re-operation (p = 0.004), but no risk factor was associated with complications. The nasolabial perforator flap is reliable for nasal reconstruction with good esthetic outcomes and fewer complications. However, a large number of involved subunits may lead to multiple surgeries for flap trimming in easterners.

Handheld Doppler Detection and Light Illumination for Vascular Mapping in Nasal Reconstruction.

The application of the expanded forehead flap in nasal reconstruction has the advantage of being able to provide a sufficient amount of flap and can provide good aesthetic results. For an expanded forehead flap to survive, there must be adequate arterial supply and venous return. Despite this, limited studies have been conducted on preoperative vascular mapping and the design of the expanded forehead flap for nasal reconstruction. In this article, the authors present a technique of hand-held Doppler detection with light illumination for vascular mapping. The study included patients who underwent total nasal reconstruction with expanded forehead flaps between May 2016 and April 2021. The design of the flap was based on the result of preoperative vascular detection by hand-held Doppler detection assisted by light illumination. A total of 32 patients underwent total nasal reconstruction with an expanded forehead flap. The distal part of the flap became necrotic 1 week after the surgery in 2 patients. Following dressing changes and the administration of antibiotics, the distal flap in these patients survived well. No complications were reported in the long term. Hand-held Doppler detection combined with light illumination is a convenient and effective preoperative design method for nasal reconstruction with an expanded forehead flap. All flaps survived well in the long term. Level IV.

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

Alar Crease Creation Suture in Nasal Reconstruction.

The crescentic alar groove serves as a topographic landmark that frames the ala and separates this convex structure from the surrounding cosmetic subunits. This aesthetic landmark can be attenuated or even obliterated during wound repair in this area. Flaps spanning the alar crease are often noticeably bulky with a pin-cushioned appearance in nasal reconstruction, and it is challenging to reproduce a natural-appearing alar groove. The authors proposed a novel technique with a modified, interrupted inverted horizontal mattress suture to create an alar groove. From March of 2016 to May of 2021, 22 consecutive patients with alar defects who underwent nasal reconstruction with the paramedian forehead flap were identified. All patients underwent the authors' novel technique for the creation of the alar groove. The mean follow-up time was 3 years 7 months (range, 14 months to 5 years). A total of 32 alar crease creation suture operations were performed. All uneven wounds healed uneventfully within 2 weeks. Two cases of postoperative fading alar grooves required alar crease creation sutures to be redone. The authors' novel alar crease creation suture is a safe, straightforward, and reliable technique to create an aesthetic alar groove in forehead flap nasal reconstruction. It can create a medially shallow and laterally deep alar crease without apparent complications. Therapeutic, IV.

Translated article] Anatomy and Design of Musculocutaneous Flaps in Nasal Reconstruction

The nose is a common site for skin tumors. The main arteries that supply the nose extend through the subcutaneous tissue. Submuscular dissection facilitates the design of safe, reliable musculocutaneous flaps that adapt well to the morphology of nasal defects. The diversity of these flaps makes them the first choice for reconstructing defects in more complex regions, such as the inner canthus of the eye and the nasal ala. We describe the surgical design of the procerus, V-Y nasalis, and lateral wall nasalis musculocutaneous flaps used to repair defects following tumor excision. The descriptions are illustrated by photographs taken by the authors during procedures and in cadaveric dissections.

A Case of Forehead Flap Nasal Reconstruction for Dog Bite Nasal Injury

A dog bite is the most common trauma among animal bites, and it has varying severity, from simple skin lacerations to defects in whole tissue layers. Considering the aesthetic and functional importance of the nose, an appropriate reconstruction should be conducted for large and full-thickness tissue defects. Although this is quite common, literature detailing surgical reconstruction is lacking, especially in domestic journals. A 45-year-old male patient visited an outpatient clinic due to nasal trauma caused by a dog bite. The patient’s nose showed whole-layer tissue defects, with necrotic tissues at the periphery. Nasal reconstruction surgery was conducted using a forehead flap and ear cartilage composite graft. Pedicle division was conducted three weeks after primary surgery. The functional and aesthetic outcomes of the surgery were satisfactory. Our experience demonstrates that the forehead flap is a useful option for reconstructing a nose badly injured by a dog bite.

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.

Soft tissue reconstruction in traumatic nasal defects by forehead flap: A tertiary care centre experience

Forehead flap is the gold standard for nasal soft tissue reconstruction. The nose is a complex three-dimensional structure and along with the eyes, represents a major aesthetic focus of the face. The aim of this study is to review the use of forehead flap in nasal reconstruction and prospectively evaluate the outcome of treating nasal defects as an easy, effective and economical treatment in the Indian population.Material and Methods: This prospective study was conducted from March 2020 to May 2022. Patients with subtotal nasal defect who were above 18 years of age, and patients who were willing to give informed consent for treatment. Each participant underwent surgical debridement under loupe magnification combined with forehead flap cover after a full clinical assessment.Results: Twenty three participants were included in this study with an age range of 18–62 years with mean age (36.1±8.71). Out of these 6(26.1%) were female and 17(73.9%) were males. The defect were located over the dorsum and lateral nasal wall in 3 participants (13.1%), tip in 2(8.7%) patients, ala in 1(4.3%) patients and involved multiple subunit in 17(73.9%).Conclusion: The forehead flap represents the ideal reconstructive choice in patients with nasal defects. It has good textural, thickness and color match when compared with the recipient site tissues, with minor complications.

Microsurgical Techniques and Postoperative Outcomes After Total and Subtotal Nasal Reconstruction: A Systematic Review.

Multiple microsurgical techniques for nasal reconstruction have been described in the literature. Given the gaps in the literature regarding evidence-based reviews for total and subtotal nasal reconstruction using microsurgical techniques, the purpose of this study was to provide a thorough presentation of the most popular microvascular techniques and their outcomes (functional and aesthetic) for total or subtotal nasal defects. A systematic search was performed using PubMed, Google Scholar, and Cochrane Library on free flap techniques for restoration of nasectomy defects. The keywords were "nasal reconstruction," "nose," "nasectomy," "rhinectomy," and "microvascular." Inclusion criteria for analysis in the study were the largest clinical case series published in English within the past 15 years with more than 8 patients.Studies were analyzed for patient demographics, etiology of nasal loss, surgical approaches to reconstruction, outcomes, and complications. The current study was registered at the International Prospective Register of Systematic Reviews and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The initial search yielded 302 results. Eleven articles with a total of 232 patients met the inclusion criteria. The radial (n = 85) and ulnar forearm flaps (n = 20), auricular helical rim (n = 87), and anterolateral thigh flap (n = 30) were the most commonly reported free flaps in nasal reconstruction. The main etiologic factors were malignancy and trauma. The most common complication was partial flap necrosis. The auricular helical and radial forearm flaps represent the most used free flaps for total and/or subtotal nasal defects with satisfactory patient outcomes.

SMaRT Assessment Tool: An Innovative Approach for Objective Assessment of Flap Designs.

The teaching and assessment of ideal surgical markings for local flaps required for optimal aesthetic and functional outcomes remain a challenge in the present era of competency-based surgical education. The authors utilized the bilobed flap for nasal reconstruction as a proof of concept for the development of an innovative objective assessment tool based on statistical shape analysis, with a focus on providing automated, evidence-based, objective, specific, and practical feedback to the learner. The proposed tool is based on Procrustes statistical shape analysis, previously used for the assessment of facial asymmetry in plastic surgery. For performance boundary testing, a series of optimal and suboptimal designs generated in deliberate violation of the established ideals of optimal bilobed flap design were evaluated, and a four-component feedback score of Scale, Mismatch, Rotation, and Translation (SMaRT) was generated. The SMaRT assessment tool demonstrated the capacity to proportionally score a spectrum of designs (n = 36) ranging from subtle to significant variations of optimal, with excellent computational and clinically reasonable performance boundaries. In terms of shape mismatch, changes in SMaRT score also correlated with intended violations in designs away from the ideal flap design. This innovative educational approach could aid in incorporating objective feedback in simulation-based platforms in order to facilitate deliberate practice in flap design, with the potential for adoption in other fields of plastic surgery to automate assessment processes.

The three-stage Forehead Flap: A Gold Standard in Nasal Reconstruction

The causes of nasal defects are dominated by skin tumors; surgical excision of these tumors sometimes leaves a large skin defect, which represents a challenge to the plastic surgeon for reconstruction. In this article, we will describe from a clinical case, the particularities of the three-stage forehead flap in nasal reconstruction as described by F. Menick, and we compare it with the classic technique in terms of aesthetic result.

Upper Margin of the Forehead Flap and Its Correlation With Aesthetic Results in Nasal Reconstruction in Fitzpatrick Skin Type III and IV Chinese.

The forehead flap is one of the most commonly used methods for nose reconstruction. To determine the ideal upper margin of the flap in nasal reconstruction and its correlation with aesthetic results. From April 2013 to September 2017, 40 patients underwent nasal reconstruction involving the dorsum with a forehead flap. The authors hypothesized 5fdifferent levels as the position to place the upper margin of the forehead flap: (1) glabella, (2) level of the upper eyelid, (3) intercanthal line, (4) horizontal line between the keystone and intercanthal line, and (5) the keystone. Then they photoshopped the upper margins of the forehead flap at 5 different levels and designed a questionnaire. Nasal reconstructive plastic surgeons, medical practitioners, and people without medical backgrounds chose the most aesthetically pleasing photograph for every patient. The questionnaire showed that the most aesthetically pleasing positions were located at glabella (n = 0), level of upper eyelid (n = 9), intercanthal line (n = 24), the line between keystone and intercanthal line (n = 6), and keystone (n = 1). The authors suggest placing the upper margin of the forehead flap at the level of the intercanthal line in nasal reconstruction involving the dorsum to achieve the best aesthetic results.

Forehead flap nasal reconstruction: oncologic and functional outcomes in a regional centre

Forehead flap nasal reconstruction: oncologic and functional outcomes in a regional centre

Different Nasolabial flaps in nasal reconstruction

Nasal reproduction is a difficult plastic medical procedure, it is the most unmistakable and stylish component of the face. Point of work is assessment, result and complexity of the nasolabial folds in nose recreation. Strategies: This examination was done in Benha University Hospital and Benha Health Insurance Hospital on thirty patients with various nasal imperfections. Subsequent to assessing the site, size, and profundity of the imperfections, recreation was finished by nasolabial folds. The folds were planned by the deliberate nasal deformities. Results and end: The mean age of the examination members was 57 years, with a standard deviation of 10 years. As to, 76.7% were guys, while 23.3% were females. The nasolabial fold is a simple, snappy and successful methodology for treatment of more modest and average estimated imperfections of the midfacial region. This method permits collecting a wide and rich vascularized fold along the entire length of the nasolabial overlap. In blend with the wide circular segment of pivot, the fold could arrive at practically any site of centrofacial territory. The closeness to the beneficiary deformities, the best shading match and the acceptable form made from the generally bare territories used from the nasolabial overlap are the other significant benefits of the method.

Use of Keystone Flaps in Consideration of the Facial Aesthetic Subunit Concept as an Alternative Reconstructive Option for Nasal Defect Coverage

Abstract Nasal defect coverage has some challenging aspects for plastic surgeons because of the midfacial location of the nose and the relationship between convexities and concavities of nasal subunits. The authors described our experience with performing keystone flap (KF) nasal reconstruction in accordance with the facial aesthetic subunit concept and demonstrated the expanding versatility of KFs in nasal reconstruction. Between January 2017 and February 2020, 15 patients (average age, 72.07 ± 13.00 years, range: 38–88 years) underwent KF reconstruction for nasal defects. We performed KF reconstruction in accordance with the facial aesthetic subunit concept. Data, including the defect causes and locations, defect sizes, flap sites and sizes, types of KFs, flap survival, complications, and follow-up period for each patient were reviewed retrospectively. Cosmetic outcomes were evaluated by independent plastic surgeons and patients through satisfactory postoperative surveys. Sixteen defects occurred in 15 patients. The defect sizes ranged from 0.8 × 1 cm to 2.5 × 3 cm. The flap sizes ranged from 1.5 × 3.5 cm to 4 × 6 cm. All defects were successfully covered with KFs from adjacent subunits. All flaps survived without any postoperative complications. At the mean follow-up period of 8.33 ± 2.92 months, the objective cosmetic outcomes were rated favorably, and the average subjective patient satisfaction score was 7.93 ± 1.28 on a scale of 1 to 10. We suggest that using KF reconstruction in consideration of the facial aesthetic subunit concept can be a promising alternative modality for covering nasal defects with outstanding aesthetic outcomes.

V-Y Flap for Nasal Reconstruction.

The nasal tip is a complex zone for reconstruction. Numerous flap reconstructions have been proposed. In addition to the technique presented here, only the Gillies-Millard bishop’s miter flap and the paramedian forehead flap should be considered. The bilobed flap should be discontinued. The double-opposing V-Y flap for nasal tip reconstruction described here is an excellent method for reconstruction of limited defects of the nasal tip. These are mirror-image cutaneous flaps which require careful, skillful technique to preserve the delicate nerves and vessels. This challenging technique should only be attempted by qualified surgeons. Triangular cutaneous flaps are marked on either side of the defect, oriented transversely. The flaps are elevated and advanced with careful, gentle dissection. Ligamentous structures are cut while preserving the neurovascular supply. No cautery is used. The procedure is performed in an operating room with local anesthesia and with the patient under IV sedation. A patient who underwent this reconstruction is shown preoperatively, early postoperatively, and late postoperatively. The results demonstrate no tip distortion with imperceptible scars. The steps to undertake this procedure are outlined in detail. Rules for nasal tip reconstruction are proposed.

Office-Based Forehead Flaps: A Safe and Reliable Reconstructive Option.

Forehead flaps are one of the workhorse flaps for nasal reconstruction, especially for large defects involving the nasal tip, ala, or multiple nasal subunits. Forehead flaps are often performed on older patients who have accompanying comorbidities and who may be at higher risk for anesthetic complications. The aim of this retrospective study was to compare the safety and success of forehead flap nasal reconstruction in 2 different clinical settings: those performed under local anesthesia in an office-based procedure room, compared with those performed in the operating room under either general anesthesia or intravenous sedation. A retrospective chart review was performed on all patients who underwent forehead flap reconstruction between the years of 2011 and 2018 by the senior author. Patient demographics, operative details, and postoperative complications were recorded and analyzed. Patients were followed for 1 year postoperatively or until the end of the study period. Patients were excluded if they had an accompanying unrelated cosmetic procedures performed during first-stage forehead flap reconstruction. A total of 96 forehead flaps were performed, 35 of which (36.5%) were done in an office-based procedure room using local anesthesia only. Patient ages ranged from 45 to 92 years, with an average age of 71.9 years. The majority of flaps (n = 81, 85.3%) were divided at the second-stage procedure. There was no statistically significant difference in time elapsed between first- and second-stage procedures between groups (procedure room: 22.6 days; operating room: 23.8 days). There were 13 total postoperative complications (13.5%), but there was no statistically significant difference in complication rate between groups (office-based: 3 complications, 8.6%; operating room: 10 complications, 16.4%). Our data suggest that forehead flap reconstruction can be done safely with acceptable postoperative results when performed under local anesthesia in an office-based outpatient setting.

Microvascular Reconstruction of Complex Nasal Defects: Case Reports and Review of the Literature.

Background:The area of nasal reconstruction can be challenging for the microsurgeon, as the nose is a complex structure. A 3-dimensional understanding of the organ is a prerequisite for a successful outcome. A combination of procedures is usually necessary to completely repair subtotal or total nasal defects. Contouring and secondary revisions may ensue to enhance the postoperative functional and aesthetic outcome of the reconstruction. This study aimed to present a review of the various methods of microvascular reconstruction for complex nasal defects based on the radial forearm flap (RFF).Methods:Two independent reviewers screened the literature on PubMed according to the inclusion criteria. The keywords for the search were “microvascular,” “nasal reconstruction,” and “free flaps in nasal reconstruction.” Articles on locoregional flap reconstruction, experimental animal studies, letters to the editors, non-English literature, and articles without full text were excluded from the study. The protocol is registered at the International Prospective Register of Systematic Reviews (CRD42019146447) under the umbrella of the National Institute for Health Research, and it is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results:Eighteen eligible studies were included in our articles. The infolding RFF, multiple skin paddles RFF, and prelaminated RFF were described. The results have been more than encouraging so far. Also, 3 clinical cases where the RFF provided intranasal lining and a forehead flap resurfaced the nose were presented.Conclusion:The RFF is a reliable technique for nasal reconstruction in expert hands.