Reconstruction Of Nasal Defects Research Articles

Full Thickness Nasal Reconstruction With Paired Pericranial and Paramedian Forehead Flaps.

The reconstruction of full-thickness nasal defects poses a significant challenge following oncologic resection. This study aims to share a technique using paired pericranial forehead flap (PCF) with contralateral paramedian flap (PMF) for such defects. Patient outcomes were reviewed, and the advantages and disadvantages of the reconstructive technique are discussed. A retrospective review of a single surgeon practice was done between 2019 and 2024. Cases of nasal reconstruction with a paired PCF and PMF following oncologic resection were reviewed. Defect characteristics, reconstructive technique, and postoperative complications were evaluated. A literature review summarizing the evolution of this technique from inception to April 2024 was conducted using PubMed. The literature review identified 7 reports describing the use of a paired PCF and PMF for nasal reconstruction. The modifications and enhancements described in each study are summarized. The case series included 13 patients requiring oncologic resection for squamous cell carcinoma (8 patients) or basal cell carcinoma (5 patients). Every case required reconstruction of at least 2 nasal subunits, primarily involving the nasal tip, alae, and columella. Reconstruction was performed with the ipsilateral PCF, contralateral PMF, and structural grafts. Auricular cartilage grafts were universally used for structural support, with additional costal cartilage grafts and a split calvaria bone graft in select cases. The technique showed good functional and esthetic outcomes without any notable graft failures or donor site complications. The combination of an ipsilateral PCF and contralateral PMF is an effective strategy for reconstructing full-thickness nasal defects involving multiple nasal subunits.

Application of free forearm flap in reconstruction of postoperative defect of external nasal malignant tumor

Objective:To investigate the therapeutic effect of free forearm flaps in repairing the postoperative defect of external nasal malignant tumor. Methods:Six patients with nasal malignant tumor were treated with radical operation of external nasal malignant tumor and simultaneous reconstruction of external nasal defects with free forearm flap. Preoperative Allen experiment, ultrasonic Doppler blood flow meter or CT angiography confirmed that the forearm blood vessels were in good condition. Results:The free forearm flaps were obtained from six patients, and completely survived. During the follow-up period of 6-12months, all patients had good external nasal morphology, good nasal function, no nasal obstruction and anterior nostril stenosis, no obvious complications in donor hand and no local cancer recurrence. Conclusion:The free forearm flap is a reliable method to reconstruction the postoperative defect of external nasal malignant tumor, with a high success rate and good recovery of morphology and function recovery.

A Comprehensive Review of Bilobed Flaps in Nasal Reconstruction: Technique, Outcomes, and Considerations.

Reconstruction of nasal defects, particularly in the lower third of the nose, presents significant challenges due to the area's complex 3-dimensional structure and thicker, more sebaceous skin. The bilobed flap, a double transposition flap, has been a popular method for addressing these nasal defects. This retrospective review examines a single surgeon's experience with bilobed flaps for nasal reconstruction over the last 15 years. Demographics, defect characteristics, intraoperative details, postoperative complications, and revisionary procedures were documented, and univariate and multivariate logistic regression analyses were used to assess complication rate associations. In all, 148 bilobed reconstructions were analyzed, with a mean patient age of 62.6 years and 46.0% male prevalence. The most common indication for the procedure was basal cell carcinoma following Mohs surgery, with the majority of the defects located on the lower third of the nose. The average defect size was 1.11cm². Complications occurred in 52.0% of cases, including pincushioning, scar thickening, asymmetry, alar stenosis, and wound dehiscence. Reoperations and additional treatments such as dermabrasion, steroid injections, and laser therapy were frequently necessary to address these issues. Logistic regression analysis demonstrated significantly more postoperative complications when the defect was located on the lower third of the nose when compared with the upper two-thirds. While the bilobed flap can provide adequate skin coverage with perfect color match, it is associated with notable complications that impact esthetic outcomes. Proper patient selection and surgical technique are crucial for optimizing results.

The Buccal Mask: Safe Positive Airway Pressure Delivery for Patients with a Paramedian Forehead Flap.

The paramedian forehead flap is commonly performed for the reconstruction of complex nasal defects. It typically requires two separate procedures: flap elevation and inset, and then, 2-3 weeks later, pedicle division. In patients with obesity hypoventilation syndrome, the use of positive airway pressure is often mandatory, especially in the postoperative period. However, the face mask used for positive airway pressure has to apply pressure over the bridge of the nose and may compromise the vascularity of a paramedian forehead flap. We report a case where a buccal mask was used successfully in the postoperative period in a patient who needed positive airway pressure after nasal reconstruction with a paramedian forehead flap.

Reconstruction of oncologic nasal defects using the forehead flap: technical aspects and results

IntroductionSkin cancer frequently hits the nasal pyramid. Reconstruction of the nasal defects of the nasal pyramid after oncologic resection is challenging for plastic surgeons due to the anatomic complexity of the nose. The forehead flap is a pedicled flap used since antiquity in the reconstruction of nasal defects.MethodsWe retrospectively reviewed the medical records of 30 patients operated for skin cancer of the nasal pyramid with reconstruction of the skin defect by forehead flap between the years 2008 and 2020.ResultsThe mean age was 66.3. The sex ratio was 2.75. The tumor mean size of the tumor was 34 mm ranging between 19 and 50 mm. Twenty-nine patients required a second time surgery for flap severing and degreasing. The paramedian forehead flap was used in 20 cases, the “sea gull” flap in 5 cases, the inclined FF in 4 cases, and the island FF in 1 case.ConclusionSurgical techniques of FF offer good aesthetic results with a lesser morbidity rate. Our retrospective report attests to the reliability of FF as the workhorse for the reconstruction of small and average nasal defects.

Prophylactic Antibiotic Use in Reconstruction of Nasal Mohs Defects.

To evaluate the effect of prophylactic antibiotics on outcomes and complications following surgical reconstructions of nasal Mohs defects in the outpatient setting. Retrospective cohort study. Single tertiary care center, July 2021 to June 2023. All adult patients who underwent reconstruction of nasal Mohs defects in an outpatient office setting were examined. Patient demographics, surgical details, prophylactic postprocedural antibiotic use, and postprocedural complications (infection, flap or graft necrosis, wound dehiscence) were collected. Outcomes and complications were compared between patients who received and did not receive prophylactic antibiotics using χ2, Kruskal-Wallis, and multivariable logistic regression. A total of 211 patients met inclusion criteria. A majority of reconstructions utilized a local flap (70%), followed by a skin or composite graft (22%), then an interpolated flap (8%). Over half of patients (55%) were prescribed prophylactic antibiotics. Postprocedural complications were documented in 16 patients (7.6%), including infection (3.3%) and flap or graft loss or necrosis (1.4%). The rate of complications did not differ based on receipt of antibiotics. The only factors independently associated with the development of complications were history of chemoradiation and reconstruction with skin or composite grafts. Prophylactic antibiotics after nasal Mohs reconstructions performed in the office setting were not associated with any differences in the rate of postprocedural complications, including surgical site infections.

Variations of the Island Pedicle Flap for Reconstruction of Nasal Defects.

Variations of the Island Pedicle Flap for Reconstruction of Nasal Defects.

Reconstruction of a Large Dorsal Nasal Defect Spanning Multiple Subunits.

Reconstruction of a Large Dorsal Nasal Defect Spanning Multiple Subunits.

An Innovative Preauricular Free Flap Pedicled with Retrograde Vascular (PFFPRV) for Pediatric Nasal Reconstruction.

Nasal reconstruction in pediatric patient is very challenging and it requires consideration of later nasal development. Herein, we introduce an innovative preauricular free flap pedicled with retrograde vascular (PFFPRV) for pediatric nasal reconstruction. In this PFFPRV technique, the retrograde superficial temporal vessels were used as the flap pedicle. The lateral alar artery and angular vein were used as vessels of the nasal recipient zone. The flap vessels were anastomosed directly to the recipient area vessels without additional vessel transplantation. Eight pediatric patients with nasal defects underwent this operation. All patients were followed up for more than 2 years. Patients' medical history data were retrospectively analyzed. Preoperative and postoperative facial photos were compared and analyzed. The satisfaction of patient's parents with the aesthetic results was assessed. All patients were successfully operated without intraoperative complications. None of the procedures required additional blood vessel grafts. One patient developed a vascular crisis the next day after the surgery and underwent vascular exploration operation. The free flaps of all patients survived without wound infection or necrosis. The color difference of flap gradually became unobvious. The transplanted flap did not show obvious contracture or retraction, and the nose was symmetrical and developed well. The parents of all patients were satisfied with the surgical results. We think this PFFPRV technique can be a reasonable alternative strategy for reconstruction of pediatric nasal defect, with no adverse effect on nasal development and no need of vascular transplantation. Level IV, therapeutic study.

Three-Dimensional Virtual Reconstruction of External Nasal Defects Based on Facial Mesh Generation Network.

(1) Background: In digital-technology-assisted nasal defect reconstruction methods, a crucial step involves utilizing computer-aided design to virtually reconstruct the nasal defect's complete morphology. However, current digital methods for virtual nasal defect reconstruction have yet to achieve efficient, precise, and personalized outcomes. In this research paper, we propose a novel approach for reconstructing external nasal defects based on the Facial Mesh Generation Network (FMGen-Net), aiming to enhance the levels of automation and personalization in virtual reconstruction. (2) Methods: We collected data from 400 3D scans of faces with normal morphology and combined the structured 3D face template and the Meshmonk non-rigid registration algorithm to construct a structured 3D facial dataset for training FMGen-Net. Guided by defective facial data, the trained FMGen-Net automatically generated an intact 3D face that was similar to the defective face, and maintained a consistent spatial position. This intact 3D face served as the 3D target reference face (3D-TRF) for nasal defect reconstruction. The reconstructed nasal data were extracted from the 3D-TRF based on the defective area using reverse engineering software. The '3D surface deviation' between the reconstructed nose and the original nose was calculated to evaluate the effect of 3D morphological restoration of the nasal defects. (3) Results: In the simulation experiment of 20 cases involving full nasal defect reconstruction, the '3D surface deviation' between the reconstructed nasal data and the original nasal data was 1.45 ± 0.24 mm. The reconstructed nasal data, constructed from the personalized 3D-TRF, accurately reconstructed the anatomical morphology of nasal defects. (4) Conclusions: This paper proposes a novel method for the virtual reconstruction of external nasal defects based on the FMGen-Net model, achieving the automated and personalized construction of the 3D-TRF and preliminarily demonstrating promising clinical application potential.

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction.

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction.

How We Do It: Forehead Flap in Combination With Hinge Advancement Flap for Through-and-Through Nasal Defect Reconstruction.

How We Do It: Forehead Flap in Combination With Hinge Advancement Flap for Through-and-Through Nasal Defect Reconstruction.

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction

A 65-year-old man presented with a Melanoma in situ of the nasal tip. Complete excision was achieved after 2 “Slow Mohs” stages, resulting in a circular 2.7 X 2.4 cm defect involving the right lateral nasal tip, dorsum and sidewall and extending to the perichondrium.

Innovative Tubularized Radial Artery Forearm Flap Technique for Comprehensive Reconstruction of Total Nasal and Anterior Palatal Defects: A Case Study

Innovative Tubularized Radial Artery Forearm Flap Technique for Comprehensive Reconstruction of Total Nasal and Anterior Palatal Defects: A Case Study

Forehead Flap Practices: A Cross-Sectional Survey of Facial Plastic and Reconstructive Surgeons.

Background: The paramedian forehead flap (PMFF) is a well-established technique utilized for reconstruction of complex nasal defects. Objective: To identify the different techniques and management of patients undergoing PMFF reconstruction and compare these with current literature. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery were sent a practice survey highlighting various nuances in PMFF reconstruction. The survey included questions about flap design, operative techniques, and perioperative care. Results: In total, 172 responses were received (14% response rate). Mean years of practice after fellowship was 15.8 years with most respondents performing either 1-5 (33.1%) or 6-10 (27.3%) PMFFs per year. Common practices included the use of general anesthesia, elevation of PMFF in the subgaleal plane (59.6%), and pedicle division at 3 weeks (80%) (p < 0.001). Complication rates ranged between 1% and 5%. The nose was the most common site for revision (p < 0.001) and the average number of secondary procedures after forehead flap division was 1.1 (standard deviation 0.81). The most variability in responses was seen for methods of internal lining reconstruction. Conclusion: Reconstructive surgeons frequently divide the PMFF pedicle at 3 weeks or later and have variable approaches to reconstruction of the internal lining with low complication rates overall.

Alar crease as a donor site for the extension limb of modified nasolabial V-Y advancement flap.

The traditional nasolabial V-Y advancement flap is widely used for midface reconstruction, particularly for the lower third of the nose and upper lip, as its color and texture are similar to these areas. However, it provides insufficient tissue to cover large defects and cannot restore the nasal convexity, nasal ala, and adjacent tissues. The purpose of this study is to investigate the modified nasolabial V-Y advancement flap with extension limbs the along alar crease for the reconstruction of complex midface defects. A retrospective analysis of 18 patients, who underwent reconstruction with the modified nasolabial V-Y advancement flap, was performed between September 2014 and December 2022. An extension limb was added along the alar crease, adjacent to the defect area, and was hinged down as a transposition flap at the end of the advancement flap. The extension limb along the alar crease successfully covered large and complicated defects, including those of the ala, the alar rim, the alar base, the nostrils, and the upper lip, with minor complications. The alar crease is a good donor site for the reconstruction of large and complex nasal and upper lip defects.

Outcome Analysis of Two-Stage Paramedian Forehead Flap for Nasal Defects Reconstruction in Local Population: Experience of 3 Years at Our Center.

The nose is a key aesthetic element of face. Nasal defect reconstruction by forehead flap has been done since ancient times. The aim of this study is to review our experience of the outcomes of two- stage paramedian forehead flap in nasal defects of various aetiologies in the local population. This prospective study was done from January 2020 to December 2022 in the Department of Plastic and Reconstructive Surgery at SMS Medical College and Hospital. A total of 29 patients were included in this study who were candidates for a forehead flap for nose reconstruction due to any aetiology. After informed and written consent, two- stage paramedian forehead flap was done and patients were followed up to 6months for analysis of outcomes. 29 participants were included in the study. Age range was 18-72years (mean age 38.5 ± 16.78). 21 (72.4%) were male and 8 (27.6%) were female.23 (79.3%) patients had multiple subunit involvement, 4 (13.8%) patients had single subunit defect and 2 (6.9%) had total nasal defect. Most common aetiology was trauma (58.7%). Early complications including flap and donor site healing related complications were present in 8 (27.5%) patients. Delayed complications were grouped into cosmetic and functional complications and were seen in 22 (75.8%) patients. Cosmetic dissatisfaction was high with the two- stage paramedian forehead flap. Forehead flap is an established gold standard reconstructive option for nasal defects. In a two stage paramedian forehead flap, flap and donor site related issues are minor but cosmetic dissatisfaction is high. With some additional stages, satisfaction among patients increases significantly.

Tunneled Island Flaps for the Reconstruction of Nasal Defects: A 21-Case Series

(1) Background: The reconstruction of cutaneous defects following surgical procedures in the nasal pyramid presents a challenge due to the limited amount of available tissue. In cases of larger defects, skin from adjacent units is used. Traditionally, two-stage surgical flaps have been employed for reconstructing these defects. Tunnelized island flaps allow for the one-stage surgical reconstruction of nasal pyramid defects, using tissue from the forehead or cheek for the flap. (2) Methods: Descriptive retrospective study of 21 consecutive patients who underwent surgery for defects on the nasal pyramid using tunnelized island flaps. (3) Results: Surgical reconstruction was performed in 21 patients with basal cell carcinomas, 14 of them using the melolabial island flap and 7 using the paramedian forehead island flap. In all cases except one, clear histological margins were obtained. Immediate complications were mild and minor. It is worth noting the trapdoor effect complication, which improved over time in most cases, resulting in a satisfactory cosmetic outcome. No tumor recurrences were observed during an average follow-up period of 17.7 months. (4) Conclusions: Tunnelized island flaps allow for single-stage reconstruction of nasal pyramid defects, yielding excellent cosmetic results by utilizing adjacent skin. This procedure demands a certain level of skill but is associated with minimal complications, making it a valuable alternative in reconstructive dermatological surgery.

A-T Flap for Reconstruction of Nasal Dorsum Skin Defects.

Reconstruction of nasal defects can be challenging, especially when encountering larger defects. We describe the use of a single-stage conversion of an 'A' shaped defect to a 'T' shaped scar of large nasal skin defects in the cosmetically sensitive supra-tip and supra-alar regions. This study aimed to determine whether an A-T flap is a suitable option for nasal reconstruction and if so where and what size defects it can be used for. Retrospective case series review over an 8-year period (2011-2019) in a tertiary referral center in the United Kingdom. Case analysis was undertaken in 2020 including all patients who underwent A-T reconstruction of nasal defects. A review of histology, case notes, and clinical photography was undertaken. A total of 27 patients were identified-13 (48%) female and 14 (52%) male. The median age was 73 years (range 31-90 years). Defect locations were supra-tip (48%) and supra-alar (52%). The largest defect closed was 895 mm2 (30 × 38 mm). Range 35 to 895 mm2 (median 264 mm2). No patient required revision or corrective procedures. No functional impairment was identified. Patient and clinician reported aesthetic outcomes as good in all cases. No reports of this technique could be identified in the literature. The A-T flap is a viable option for supra-tip and supra-alar skin defects (up to 895 mm2 in our series). It aligns well with the basic principles of nasal reconstruction. The flap can be performed under local anesthesia in one stage, resulting in good functional and aesthetic outcomes and so can be considered a valuable tool for the nasal reconstructive surgeon.

Patient Satisfaction Following Primary Closure or Second Intention Healing After Conventional Nasal Skin Cancer Excision: A Cross-sectional Cohort Study.

Nasal reconstruction after conventional surgical excision (CSE) of nonmelanoma skin cancer (NMSC) can be challenging. After excision and before the pathologic report, a simple reconstruction is favored. Yet, little is known about patient satisfaction after primary closure and second intention healing. Patient satisfaction after nasal defect reconstruction with primary closure or second intention healing, using the FACE-Q Skin Cancer. All patients who underwent CSE of nasal NMSC with immediate primary closure or second intention healing between March 2018 and March 2020 at Máxima Medisch Centrum Veldhoven were identified and asked to complete the FACE-Q Skin Cancer. Of 183 patients, 140 patients completed the questionnaire. Fifty-five defects were closed by primary closure (38.5%) and 88 by second intention healing (61.5%). Thirty-one complications were reported (16.7%), of which 87.1% ( n = 27) after second intention healing ( p = .004). Both groups experienced high facial and scar satisfaction, low appearance-related distress, and no to minimal adverse effects. Second intention healing had 2.7 higher odds of achieving the maximum scar satisfaction score ( p = .02). This study shows high satisfaction on facial and scar appraisal, low appearance-related distress, and no to minimal adverse effects for second intention healing and primary closure after CSE of nasal NMSC.