Local Flaps Research Articles

Tuberous Breast: A Wide Spectrum of Features of the Same Disorder-13-Year Experience-Based Classification and Reconstructive Algorithm.

A multitude of variants of tuberous breast exist, and a reconstructive algorithm could help in assessment of all features that affect the breast and planning the most appropriate surgical correction strategy. Although several efficient techniques have been described in the literature, the authors propose their experience to help standardize a diagnostic and therapeutic approach. The aim of this article is to assess the pathologic hallmarks of each type of tuberous breast and to propose a one-step reconstructive algorithm tailored to the patient characteristics based on the use of three different adipo-glandular flaps. From September of 2006 to December of 2019, 118 patients were treated for tuberous breast in a one-step procedure using tailored local flaps according to the preoperatively assessed clinical variant. Minimum follow-up was 12 months. All the procedures were performed under local anesthesia. A total of 220 tuberous breasts (98 hypoplastic and 122 normoplastic) were treated. Mean patient age was 20.2 years. Mean follow-up was 36.5 months. Six minor complications (capsular contracture and nipple-areola complex hypesthesia) but no major complications were reported. In 9% of cases, minor secondary procedures, including lipofilling, scar revisions, and breast implant substitution, were performed. The proposed algorithm, including a comprehensive classification, preoperative planning, and surgical approach derived from the authors' experience, presents a tailored surgical approach for each type of tuberous breast. Therapeutic, IV.

Reconstructive Options after Oncological Rhinectomy: State of the Art.

The nose is a central component of the face, and it is fundamental to an individual's recognition and attractiveness. The aim of this study is to present a review of the last twenty years literature on reconstructive techniques after oncological rhinectomy. Literature searches were conducted in the databases PubMed, Scopus, Medline and Google Scholar. "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)" for scoping review was followed. Seventeen articles regarding total rhinectomy reconstruction were finally identified in the English literature, with a total of 447 cases. The prostheses were the reconstructive choice in 213 (47.7%) patients, followed by local flaps in 172 (38.5%) and free flaps in 62 (13.8%). The forehead flap (FF) and the radial forearm free flap (RFFF) are the most frequently used flaps. This study shows that both prosthetic and surgical reconstruction are very suitable solutions in terms of surgical and aesthetic outcomes for the patient.

A 10-year experience in microsurgical reconstruction of the nose with a lower extremity flap

BackgroundTraditionally, radial forearm free flaps are utilized for nasal lining reconstruction when local flaps cannot provide adequate coverage. However, according to our clinical observation, the skin of the forearm flap is relatively thin and prone to collapse. We present a series of nasal reconstructions using free flaps harvested from the lower extremities to determine if the thick flap could provide more support and decrease the tendency of airway collapse. MethodsFrom March 2011 to July 2021, we identified 15 patients who underwent total or subtotal nasal reconstruction with free flap from the lower extremities (10 anterolateral thigh flap, 4 medial sural artery perforator flap, and 1 profunda artery perforator flap). We included 15 patients who underwent free forearm flap reconstruction as controls. The Nasal Obstruction Symptoms Evaluation (NOSE) score was utilized to subjectively evaluate the degree of nasal obstruction symptoms. ResultsThe lower extremity group had a lower NOSE score than the forearm group (25.4 vs. 40). It took more time (6.5 vs. 4.2 months) and more surgeries (4.6 vs. 2.6) from the first free flap reconstruction till forehead flap reconstruction in the lower extremity group than in the forearm group, although the total number of surgeries was comparable between the 2 groups (7.2 vs. 8.1). ConclusionsUtilizing free flaps from the lower extremities in total or subtotal reconstruction of the nasal lining may decrease the tendency of flap collapse and alleviate airway obstruction symptoms and may also allow reconstruction of surrounding defects simultaneously compared with using forearm flaps.

The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations.

Chronic lower extremity wounds affect up to 13% of the US population. Transmetatarsal amputation (TMA) is frequently performed in patients with chronic forefoot wounds. TMA allows limb salvage and preserves functional gait, without need for prosthesis. Traditionally, when tension-free primary closure is not possible, a higher-level amputation is performed. This is the first series to evaluate the outcomes of local and free flap coverage of TMA stumps in patients with chronic foot wounds. A retrospective cohort of patients who underwent TMA with flap coverage from 2015 through 2021 was reviewed. Primary outcomes included flap success, early postoperative complications, and long-term outcomes (limb salvage and ambulatory status). Patient-reported outcome measures using the Lower Extremity Functional Scale (LEFS) were also collected. Fifty patients underwent 51 flap reconstructions (26 local, 25 free flap) after TMA. Average age and body mass index were 58.5 years and 29.8 kg/m 2 , respectively. Comorbidities included diabetes [ n = 43 (86%)] and peripheral vascular disease [ n = 37 (74%)]. Flap success rate was 100%. At a mean follow-up of 24.8 months (range, 0.7 to 95.7 months), the limb salvage rate was 86.3% ( n = 44). Forty-four patients (88%) were ambulatory. The LEFS survey was completed by 24 surviving patients (54.5%). Mean LEFS score was 46.6 ± 13.9, correlating with 58.2% ± 17.4% of maximal function. Local and free flap reconstruction after TMA are viable methods of soft-tissue coverage for limb salvage. Applying plastic surgery flap techniques for TMA stump coverage allows for preservation of increased foot length and ambulation without a prosthesis. Therapeutic, IV.

Bipedicled Scalp Flap for Coverage of a Frontal Loss of Substance: About One Case

Introduction: Scalp defects are frequent in the daily practice of plastic surgeons. Their etiologies are multiple; they can be of tumoral origin, infectious, secondary to a burn, post-traumatic… The great vascular richness of the scalp explains the possibility of using local flaps. Clinical Case: This is an 80-year-old patient with ATCD: arterial hypertension under treatment. The onset of symptoms dates back 10 years when the patient was operated on by neurosurgeons for a frontal meningioma for which she underwent excision + cranioplasty. The patient presented after 10 years for cranioplasty rejection with signs of local infection. The decision to remove the prosthetic material and cover the loss of substance was taken. After removal of the cranioplasty material by the team of neurosurgeons, we decided to perform a bi-pedicled scalp flap vascularized by the occipital pedicle and the posterior auricular pedicle, the donor area was grafted. The postoperative course was unremarkable. The result was considered good without complications. Conclusion: The anatomical particularities of the scalp explain all the originality of the reconstructions of this region. In our patient, the advantage of using the bipediculated flap is its extreme reliability, especially when the cranial vault has to be sacrificed.

Oroantral communications: a literature review and update

Introduction: the Oroantral Communication (OAC) is the space that is created between the maxillary sinus and the oral cavity, which if not treated will progress to an Oroantral Fistula (OAF) or chronic sinus disease. The most common predisposing factor for a COA is the extraction of the upper posterior teeth (usually the first or second molars). The aim of this study was to carry out a literature review with emphasis on clinical implications and treatment alternatives of a COA through an update and review of information of interest. Methods: a literature review was carried out through a collection and analysis of bibliography of oroantral communications and the comparison and treatment alternatives. Discussion: various techniques have been proposed for the management of an AOC, among which are local flaps, as well as the use of biomaterials, which have given favorable results in closing the defect. Conclusion: the treatment of an AOC has as purpose to prevent its progression to an AFO, the development of sinusitis and/or that the defect increases; To do this, the clinician must be familiar with the various techniques based on the patient's needs.

Reconceptualization of Proximal Nail Fold Reconstruction: Skin Grafting over the Nail Plate.

The structure of the periungual area is complicated, resulting in historically difficult morphological reconstruction after trauma or cancer resection. There is also no established standard for its reconstruction; thus, we aimed to use a full-thickness skin graft (FTSG) over the nail plate. Three patients with Bowen disease on their proximal nail fold (PNF) underwent excision with a 2-mm margin preserving the nail matrix, and a temporary wound dressing was applied. The FTSG was harvested from the ipsilateral ulnar wrist joint and placed over the skin defect, including the nail plate. Initially, the FTSG seemed to have shrunken; however, after 3 months, it extended and the PNF had a good color and texture match. Remarkably, the FTSG adhered to the nail plate, and the complex PNF structure appeared well reconstructed. Occasionally, a local flap is used; however, it is limited to small defects and causes a deformity of the periungual structure. In this study, the reconstructed PNF showed good results. We presumed that the bridging phenomenon caused graft survival on the nail plate, and that the presence of stem cells near the nail matrix caused graft extension and eponychium and cuticle regeneration. Specifically, the acquisition of sufficient raw surface around the nail plate and wound preparation after excision resulted in the former, and the nail matrix preservation after excision contributed to the latter. This surgical technique is simple and can therefore be considered a remarkably effective method for periungual area reconstruction to date.

Surgical Management of Tophaceous Gout in the Upper Limb

Gouty tophi are a clinical manifestation of hyperuricemia in advanced stages. They can produce pain, functional limitation, and severe deformities. Patients with severe symptoms require short-term symptomatic solutions that standard medical management is not able to provide. The objective of this study was to present the results obtained with the surgical management of tophaceous gout in the upper limb, as well as present a detailed characterization of the disease in the upper limb. Databases of the hand surgery service of a quaternary care hospital were reviewed to identify patients aged >18 years old undergoing tophi resection in the upper limbs between 2014 and 2020. Medical history records were reviewed retrospectively, and the relevant data were extracted to establish demographic profile, clinical presentation, anatomic distribution, postoperative outcomes, and additional procedures required. The most frequent symptom was pain (83%), followed by limited range of motion (56%), deformity (50%), and daily living/occupational activity limitation (28%). The main indications for surgical management were the presence of deformity, pain, and/or limited range of motion. The most frequently affected anatomic sites were the metacarpophalangeal joints, followed by the elbows, proximal interphalangeal joints, and proximal phalanges. The postoperative complication rate was 28%. The most common complications were operative site infections and wound dehiscence. Decreased pain was associated with surgical resection. Additional procedures, such as extensor tenorrhaphy and local flaps, were required in 47.2% of patients. Surgical resection of tophi can decrease pain. Although surgery is associated with ahigh rate of complications, most are minor. Therapeutic IV.

Revisiting Bipedicled Flaps for Lower Extremity Distal Third Defects.

Lower extremity reconstruction of the distal third of the leg is challenging. Free tissue transfer is the criterion standard. The COVID-19 pandemic encouraged seeking alternatives for resource consuming procedures. Bipedicled flaps are flaps with a dual-source subdermal perfusion. The purpose of this study was to assess outcomes of patients who had bipedicled flaps primary or auxiliary local flap for distal third leg/foot reconstruction. A retrospective review of patients undergoing lower extremity reconstruction (2020-2021) was performed. Inclusion criteria were patients older than 18 years with lower extremity wounds secondary to traumatic injury for which bipedicled flaps were used in the reconstruction. Exclusion criteria included lower extremity wounds secondary to peripheral vascular disease or diabetes. Fourteen patients were included in the study. All patients had distal third of the leg/foot wounds, and 12 patients (87.5%) had concurrent leg fractures. In 8 patients (57.1%), the bipedicled flap was used to decrease the wound size and facilitate another concurrent flap: hemisoleus (21.4%), anterior tibialis muscle turnover (14.3%), medial plantar artery (14.3%), and posterior tibial artery perforator (14.3%). Mean wound size for bipedicle flaps used alone was 42.0 ± 18.3 cm2, whereas wounds that required a bipedicled flap with an additional flap were 69.9 ± 80.8 cm2 (P = 0.187). Two patients had partial flap necrosis (14.3%) but healed their defect. One patient had nonunion (7.1%). Limb salvage rate was 100%. Bipedicled flaps can be used as an alternative to free flaps in distal third leg/foot defects in select patients. If distal extremity wounds cannot be covered with a bipedicled flap alone, the flap can be used an accessory flap to facilitate reconstruction with other local flaps.

Supraclavicular Artery Island Flap for Head and Neck Oncologic Reconstruction: 15-year Experience, Past, Present, Future

Background: Head and neck reconstruction poses unique challenges due to the complex structure of the region. Primary goals include soft-tissue coverage, adequate color and texture match, and minimal donor-site morbidity. Local and musculocutaneous regional flaps have largely been replaced with fasciocutaneous free flaps (FFF) over recent years. The supraclavicular artery island flap (SCAIF), a locoregional, fasciocutaneous, axially-based flap, has been shown to produce similar outcomes to FFF. We present our 15-year experience using the SCAIF for head and neck reconstruction, discuss its evolution, and provide case examples for its range of indications. Methods: Retrospective chart review identified 128 patients who underwent reconstruction of the head and neck with the SCAIF between the years 2006-2021 at Tulane University Medical Center. Patient demographics, lengths of stay, operative times, surgical indications, and complications were recorded. Results: The cohort mean age was 66.9 years. Mean lengths of stay and follow-up times were 6.9 days and 9.1 months, respectively. The most common indications for SCAIF reconstruction were recurrent radiated neck disease (n=27, 21.1%), pharyngeal wall defects (n=23, 18.0%), and parotidectomy defects (n=21, 16.4%). Overall complication rate was 17.2%. Partial thickness flap loss (5.5%), contained pharyngeal leak (3.2%), and distal tip necrosis (2.4%) were the most common complications. No functional donor site morbidity was encountered. Conclusions: The SCAIF is a versatile, fasciocutaneous, axially-based flap able to produce similar outcomes to FFF in the reconstruction of the head and neck region while reducing costs, lengths of stay, operative times, and donor site morbidity.

Masculinizing and defeminizing gender-affirming surgery.

Transmasculine transgender and gender-diverse individuals may request gender-affirming surgery, standalone or in addition to other interventions. The choices and preferred outcomes of surgery can be highly individual. Besides surgeons' technical skills and patient physique, professionals in this field should be able to cooperate with other disciplines and with patients. The most requested surgery is masculinizing chest surgery, aiming to create a masculine chest with minimal scarring. For genital surgery, metoidioplasty refers to the procedure where the hypertrophic clitoris is released and possibly a scrotum is created from local labia flaps, whereas phalloplasty refers to a procedure in which a neophallus is created from a flap. Possible other surgeries include hysterectomy/oophorectomy, colpectomy, and the implants of scrotal or erection prostheses. In order to guide patients and clinicians, standardized outcome measures as well as evidence-based decision aids have been developed. Such aids, in combination with collaborative medical and psychosocial care, may further leverage the long-term outcomes of these surgeries.

Propeller posterior tibial artery perforator flap for reconstruction of the medial malleolar defect: A case report

Abstract Traumatic injury to the distal third of the lower leg remains challenging and often requires free tissue transfer. Reconstructive options for lower leg soft-tissue defects require comprehensive evaluation. A 20-year-old man presented with a medial malleolar soft-tissue defect with exposure of the great saphenous vein, distal tibia, and ankle joint after a traffic accident. Negative pressure wound therapy provided only partial coverage of the exposed tissue. The defect was reconstructed using a local fasciocutaneous propeller flap based on a septocutaneous perforator from the posterior tibial artery. At 1-year follow-up, the patient resumed normal daily activities without functional deficits. We review the options of reconstructing the distal third of the lower leg and surgical pearls of propeller flaps. Propeller flaps provide adequate tissue-like and pliable soft tissue coverage with a short operation time. It can be a useful technique for the reconstruction of distal third lower-leg defects.

Atypical Angiosarcoma with a Solitary Erythematous Nodule on the Cheek: A Case Report

Angiosarcoma is a very rare subtype of sarcoma. It mainly occurs in the head and neck, and cutaneous angiosarcoma in this region seems to be a distinctive neoplasm with characteristic clinicopathologic features that differ from those of angiosarcoma in other anatomical locations. The prognosis of angiosarcoma in the head and neck region is poor, and the risk of local recurrence and metastasis is high. We reconstructed an atypical angiosarcoma that presented as a solitary nodule with a shape suggestive of hemangioma on the cheek using a modified bilobed local flap. At a 12-month follow-up visit, the patient in this case showed successful recovery after radiation therapy.

Simplified Zygomatic Implant Perforated (Zip) Flap for Rehabilitation in Low Level Maxillary Defects

Rehabilitation in Low level maxillectomy cases has plethora of options right from local flaps to microvascular flaps. Subsequent to flap surgery, a maxillary dental rehabilitation can be demanding and a fixed or removable prosthesis is obligatory to provide them with near-normal function and aesthetics. Unlike the original ZIP flaps which were dedicated to microvascular flaps, we present here our unique experience with ZIP-Temporalis flap specifically for rehabilitation for patients of CAM (covid associated mucormycosis), its methods, advantages and limitations.

Reconstruction challenges for complicated preauricular sinuses: case reports

Preauricular sinuses and pits are congenital anomalies located in or just in front of the ascending limb of the helix. Even though excising a sinus is a relatively minor surgical procedure, recurrence is not uncommon if an adequate resection is not done. Surgery is only indicated when it is complicated by recurrent infection or abscesses. Simple closure may not be possible when there is large tissue defect. In those circumstances local flaps will be required to cover the defect. In this article we report 2 cases which had large tissue defect after excision and closed with local rotational flaps. This provided good cosmetic outlook and no recurrences so far. There are not enough articles published so far with such kind of reconstruction techniques for preauricular sinus excision tissue defects.

Hybrid double-dermal flap technique for vest-over-pants-closure correction of depressed abdominal scars.

Surgical procedures performed during neonatal period or childhood that result in vertical midline, transverse left upper quadrant, or central upper abdominal scars create significant psychological concerns in adulthood. Various surgical techniques correct depressed scars, including scar revision, Z- or W-plasty flaps, sub-incision tunnelling, fat grafting, and autologous or alloplastic dermal grafting. This article describes a novel technique for repairing depressed abdominal scars using hybrid double-dermal flaps. We included patients with psychosocial concerns who underwent abdominal scar revision because of wedding plans. Hybrid local de-epithelised dermal flaps were used to correct the depression of the abdominal scar. Superior and inferior skin flaps, medial and lateral to the depressed scar, were de-epithelised for 2 to 3 cm and sutured using the vest-over-pants technique with 2/0 nylon permanent sutures. Six female patients who want to marry were included in this study. Depressed abdominal scars were successfully fixed using hybrid double-dermal flaps, either from the superior-inferior aspect for transverse scars or from the medial-lateral aspect for vertical scars. No postoperative complications were noted, and the patients were satisfied with the outcomes. De-epithelialised double-dermal flaps in the vest-over-pants technique are an effective and valuable surgical technique for correcting depressed scars.

(476) Contemporary Mmanagement of Penile Foreign Body Injections

Abstract Introduction Foreign body injections were first used, in the form of mineral oil, in 1899 to augment men post orchidectomy for tuberculous orchitis. In the 1940s and 1950s, documented cases of purposeful penile foreign body injections started to be reported as “penile paraffinomas.” Their surgical correction is challenging due to the risk of skin necrosis and wound breakdown. Objective The aim of the study is to present a large case series of 31 penile paraffinomas to examine the management and complication rates in the modern era. Methods Retrospective review of penile paraffinomas managed at a single institution over a 15-year period (2006-2021). Patient demographics, surgical management and functional outcomes were extracted from both paper and electronic medical records. Results Median age at time of referral was 34 (IQR=10.5). Median age at time of first injection was 30 years (IQR=11.5). The substances injected were silicone (47%), paraffin (25%), mineral oils (22%), and unknown (6%). The most common presenting symptoms was pain (44%) but other reasons included concerns for cosmesis (21%) and penile tightness or phimosis (21%). Only 1 man presented with ulceration and skin necrosis. Most (97%) underwent surgical reconstruction with a median of 2 operations per man (range 1-7) and 66 operations in total. Excision with primary closure was possible in 62% of the operations with circumcision required in 18% (Table 1). Closure was by local tissue flap in 3% but split (5%) or full (5%) thickness skin grafts were sometimes required. Complications occurred in 15% (n=10) with the most common being wound breakdown (n=6) followed by skin necrosis (n=3). There was 1 scrotal haematoma that required surgical drainage (Clavien 3b). Median follow-up after the last operation was 2 months (range 0-19 months) with 70% (n=22) lost to follow-up at some point. Erectile dysfunction and loss of penile sensation were uncommon following surgery (7%, n=2 and 3%, n=1 respectively). Only 7% (n=2) of men expressed dissatisfaction with the overall result of their treatment. Conclusions Penile paraffinomas are rare and difficult to treat. Performing repeated staged revision surgery reduces the risk of complications by allowing time for healing between each procedure. Our complication rates are consistent with other contemporary reports. Very few men expressed dissatisfaction with their treatment despite their limited follow-up due to the severity of their presenting problem. Disclosure No

Current practice and provision of oncoplastic breast-conserving surgery in the UK: results of the ANTHEM national practice questionnaire.

Oncoplastic breast-conserving surgery (OPBCS) may be a better option than mastectomy ± immediate breast reconstruction (IBR) for women with breast cancer but studies directly comparing the techniques are lacking. We surveyed UK breast units to determine the current practice of OPBCS to inform the design of a future comparative study. An electronic survey was developed to explore the current practice of OPBCS. This included the local availability of volume displacement and/or replacement techniques; number of cases performed; contraindications and approach to contralateral symmetrisation. Summary data for each survey item were calculated and overall provision of care examined. 58 UK centres completed the survey, including 43 (74%) stand-alone breast and 15 (26%) combined breast/plastics units. Over 40% of units (n = 24) treated more than 500 cancers/year. Most units offered volume displacement techniques (TMs) (97%). Over two-thirds (n = 39. 67%) of units offered local perforator flaps (LPF). Approximately a half of units (10/19) not performing LPF were planning to introduce them in the next 12-24months. A third (n = 19, 33%) of units routinely performed simultaneous contralateral symmetrisation mostly with two-surgeon operating. There were limited oncological restrictions to OPBCS with no contraindications for multifocal cancers in most centres; 65% of units (36/55) offered OPBCS for multicentric disease. Extensive DCIS was a contraindication in a minority of units. OPBCS is widely available in the UK but contraindications and approaches to contralateral symmetrisation were variable. Work is now needed to prospectively evaluate the outcomes of OPBCS vs mastectomy ± IBR to support informed decision-making.

88. 90-Day Readmissions in Patients with Diabetic Foot Ulcers Undergoing Soft-tissue Reconstructive Surgery- A Risk Factor Analysis Using the HCUP - Nationwide Readmissions Database

PURPOSE: Soft-tissue reconstruction is an integral component in the long-term management of diabetic foot ulcers (DFUs) and is indispensable to mitigating the undue morbidity, mortality, and economic costs associated with DFUs. In this study, we aim to investigate the rate of 90-day readmissions in patients with a DFU who have been treated with a soft-tissue reconstructive surgery. We also intend to characterize the risk factors associated with readmission in this patient cohort. METHODS: We retrospectively queried the Healthcare Cost and Utilization Project’s Nationwide Readmissions database (HCUP-NRD) containing 35 million patient records, from 2016 to 2017, for adult patients who underwent any soft-tissue reconstructive procedure (skin grafting, local flap, and free tissue transfer) for the treatment of a diabetic foot infection. Patient records satisfying the inclusion criteria were extracted using a combination of ICD-10-CM diagnostic codes and ICD-10-PCS procedure codes. Data were weighted and readmissions occuring within the 90 day period of an index admission were estimated in accordance with the HCUP guidelines. A risk factor analysis was performed using univariable and multivariable logistic regression models, with readmission as the dependent variable, to find independent risk factors for readmission in this population. RESULTS: Our final weighted sample cohort consisted of 4,325 adult diabetic patients who had undergone a soft-tissue reconstructive surgery for a diabetic foot infection. Among them, 1,377 patients (31.8%) were readmitted within the 90-day study period. Readmission rate varied depending on the type of procedure performed and was 30.5%, 32.4%, and 38.4% among patients who received skin grafts, local flaps, and free flaps respectively. On performing multivariable analyses, we found that, controlling for all other variables, being operated on in a small metropolitan hospital was associated with 24% lower odds of 90-day readmission as compared to being operated on in a large metropolitan hospital (aOR=0.76, CI=0.60-0.96, p=0.025). However, having chronic kidney disease at baseline was associated with 28% higher odds of 90-day readmission (aOR=1.28, CI=1.02-1.58, p=0.02). Additionally, congestive heart failure at baseline was associated with 55% higher odds of 90-day readmission (aOR=1.55, CI=1.22-1.96, p<0.001). CONCLUSION: Chronic kidney disease and congestive heart failure at baseline were independent risk factors for readmission among patients who underwent soft-tissue reconstruction of the diabetic foot. A multidisciplinary approach to perioperative management of comorbid condit

Difficulties of nasocutaneous fistula repair, following lacrimal outflow system malignancy resection

ABSTRACT Purpose To evaluate the incidence of nasocutaneous fistula (NCF) development, following en bloc resection of lacrimal outflow system malignancies (LOSM), and describe the methods of surgical repair. Methods Retrospective review of all patients who underwent resection of LOSM with reconstruction and post-treatment protocol at the University of Miami between 1997 and 2021. Results Of the 23 included patients, 10 (43%) developed postoperative NCF. All NCFs developed within one year of surgical resection or completion of radiation therapy. NCF was seen more frequently in patients who underwent adjuvant radiation therapy and those who had reconstruction of the orbital wall with titanium implants. All patients underwent at least one revisional surgery to close the NCF, including local flap transposition (9/10), paramedian forehead flap (5/10), pericranial flap (1/10), nasoseptal flap (2/10), and microvascular free flap (1/10). Local tissue transfer, pericranial, paramedian, and nasoseptal forehead flaps failed in most cases. Two patients had long-term closure; one patient who underwent a paramedian flap and a second who underwent a radial forearm free flap, suggesting that well-vascularized flaps may be the most viable option for repair. Conclusions NCF is a known complication, following en bloc resection of lacrimal outflow system malignancies. Risk factors for formation may include adjuvant radiation therapy and use of titanium implants for reconstruction. Surgeons should consider utilizing robust vascular-pedicled flaps or microvascular free flaps for repair of NCF in this clinical scenario.