Reconstruction Of Nasal Defects Research Articles

Melolabial interpolation flap with ear cartilage graft in the reconstruction of nasal defect caused by basal cell carcinoma

Melolabial interpolation flap with ear cartilage graft in the reconstruction of nasal defect caused by basal cell carcinoma

Nasal tip defect reconstruction using advancement flap: case report

Nasal tip defect reconstruction using advancement flap: case report

Broadening applications and insights into the cross-paramedian forehead flap over a 19-year period

Forehead flap reconstruction of large nasal defects can be challenging. The senior author has used a paramedian forehead flap modification using the supratrochlear artery on the contralateral side of the defect. A 9-year retrospective review (2008-2016) was performed for patients undergoing nasal reconstruction with the cross-paramedian forehead flap. Outcomes were analyzed by comparing our previous reviews, which allows us to analyze patient outcomes for over 19 years. Fifty-three patients were identified. The aasal defect was most frequently due to basal cell carcinoma (n=37, 69.8%). Twenty-three (43%) patients were smokers, and nine (17%) had diabetes. The mean defect size was 12.9cm2, involving an average of 2.6 nasal subunits. One-third of the patients had cartilage defects (n = 18) and mucosal lining defects (n = 19). Periorbital involvement was present in five patients. Complications included partial flap loss (n = 6), donor site dehiscence (n = 4), flap dehiscence (n = 2), and postoperative infection (n = 1). Only two of the partial flap losses were considered significant, as they required additional reconstructive procedures for soft tissue coverage. Complications were 12 times as likely as those in diabetes (OR=11.97, p=0.007, 95% CI 1.94-72.44), six times as likely as those in cartilage defects (OR = 6.4, p = 0.007, 95% CI 1.64-24.92), and nearly five times as likely as those in mucosal lining defects (OR = 4.8, p = 1.27-18.09, 95% CI 1.27-18.09). Thirty-one patients required revisions most commonly for flap debulking (n = 16). The cross-paramedian forehead flap is a reliable option in the armamentarium of the reconstructive surgeon for large and complex defects in addition to those with periorbital extension. Coverage of distal nasal defects after tumor extirpation remains a challenge to the reconstructive surgeon. Our institution uses the cross-paramedian forehead flap for these defects. This flap is based on the supratrochlear artery on the contralateral side of the defect and is oriented obliquely across the forehead for additional length and an improved donor site scar at the level of the eyebrow. The technique and outcomes were published in 2009, and this manuscript serves as an update on outcomes and applications during the past 9 years. By including all our data, we can analyze outcomes for over 19 years. During the past 9 years, 53 patients underwent the cross-paramedian forehead flap technique between 2008 and 2016. These patients were found to have an average defect size of 12.9cm2 and an average loss of 2.6 nasal subunits. Cartilage defects were present in 34.6% (n = 18) and mucosal defects were present in 36.5% (n = 19) of patients. Five patients had periorbital reconstruction with the forehead flap, of which three patients underwent a single-stage islandized forehead flap reconstruction. Given the large defect size, additional local flaps were frequently used, including nasolabial flaps (n = 16) and cheek rearrangement (n = 11). Complications included partial flap loss (n = 6), donor site dehiscence (n = 4), and postoperative infection (n = 1). Only two of these partial flap losses were considered significant, as they required additional reconstructive procedures to address areas of soft tissue loss. Increased rates of complications were associated with the presence of diabetes and defect characteristics, which reflects increased complexity including mucosal and cartilage loss. When comparing with our prior review of this technique, the more recent population have had increasing complexity of the nasal defects with a large surface area involvement. Overall, the cross-paramedian forehead flap is a reliable option in the armamentarium of the reconstructive surgeon for large and distal nasal defects.

Expanded Paramedian Forehead Flaps for Nasal Defects: Beyond Aesthetic Subunits.

Reconstruction of nasal tip defects presents a significant challenge for plastic surgeons. The form, function, and aesthetic appeal of all nasal subunits must be addressed. The expanded paramedian forehead flap is a good choice for nasal reconstruction, providing similar texture, structure, and skin color, and high reliability. This article discusses the authors' modification of the expanded paramedian forehead flap in reconstructing defects on or around the nasal tip. Twenty-two patients with nasal defects located on or around the nasal tip were treated in our institution. Sixteen patients underwent nasal reconstruction with expanded forehead flaps. The other 6 cases with cartilage defect underwent reconstruction with expanded forehead flaps and autogenous rib cartilage grafts. Functional and cosmetic results were assessed by surgeon, patient, and patient's relatives using a scale from 1 to 10. The aesthetic appearance of all patients was significantly improved after surgery. Two cases had mild hyperpigmentation. Two patients considered the flaps too thick. Three cases had minor brow elevation at the donor site. There were no obvious scars at the donor sites. There were no serious complications, such as infection, flap necrosis, deviation, or collapse. The expanded paramedian forehead flap is a safe and effective method for reconstructing defects located on or around the nasal tip. Moreover, this technique can result in good functional and cosmetic outcomes with very few complications.

Clinical efficacy of facial artery perforation nasolabial flap in reconstruction of nasal defect

Objective To evaluate the effects of nasolabial flap with facial artery and its branches perforator for reconstruction of nasal defect. Methods Between March 2013 and April 2017, 21 patients underwent operations for the reconstruction of nasal defect, caused by trauma, surface tumors, moles and infection. The size of the defect was 1.5 cm × 2.0 cm to 3.0 cm × 3.0 cm. Designed various nasolabial perforator flap was pedicled with the facial artery. The pulsed blood flow detector determined the location of the facial artery and its perforation position, which was the rotation point, and the rotation of the nasolabial fold flap covered the nasal defect area to repair. Results 21 flaps survived. Surface artery perforation nasolabial fold flap was good blood supply, of which 1 case of flap was congested and recovered after treatment. After 1 month to 3 years follow-up on 21 cases, 20 cases showed good results and 1 case had generally accepted. The color, shape and function of the flap were significant, similar to the normal skin. Conclusions A small area defect in the nose is preferred by using facial arterial perforation nasolabial fold flap repair, which does not need secondary repair, and is worthy of clinical application. Key words: Nose; Nasolabial fold; Perforators flap; Reconstructive surgical procedures; Defects

The pedicled levator labii superioris alaeque nasi flap: A durable single-stage option for reconstruction of full-thickness nasal defects.

Repair of full-thickness nasal defects can often be associated with multi-stage operations that can result in significant physical and psychological morbidity for patients. We present a single-stage option for reconstruction of these defects. Demonstrate the utility of the pedicled levator labii superioris alaeque nasi flap and consistency of its vascular pedicle. Anatomical study using fresh cadavers. Academic medical center. Evaluation of vascular anatomy of pedicled flap and measurements of distances with relationship to facial anatomic landmarks. With few noted anatomic variations, the vascular pedicle of the pedicled levator labii superioris alaeque nasi flap arises from the superior labial artery and is reliably located within 1 cm lateral and inferior of the nasal sill. As a robust single-stage option, the pedicled levator labii superioris alaeque nasi flap can serve as a powerful option in the arsenal of the reconstructive surgeon. The technique for harvest is simple with attention to a few anatomic variations as described herein, and excellent results can be obtained with proper application.

A Combination Flap for Nasal Defect Reconstruction.

Nasal reconstruction is a common plastic surgery procedure following cancer resection. Whereas most small and medium defects are managed using standard local flaps, reconstructive options available for large defects of the nose such as a heminasal defect are very few. Most of the large defects are usually managed using a forehead flap, which involves at least 2 stages or using free tissue transfer. The author describes a combination flap that can be used for reconstruction of heminasal defects as well as lateral wall defects. A cheek advancement flap with the nasolabial flap incorporated in it as a combined flap was used for reconstructing heminasal defects and lateral wall defects in 11 patients. Four of the cases were following Mohs surgery for skin cancer, and others, primary reconstruction following wide excision of skin cancer. Five of the cases required cartilage support with or without lining, and others were skin-only defects. All were done as single-stage procedures. The cases were followed up over a period ranging from 6 to 18 months. There were no immediate complications in any of the cases, and all flaps survived completely. Assessment was done in terms of function, appearance, requirement for further procedures, and patient satisfaction. Outcome was deemed excellent in 8 patients. One patient had deviation of the nasal septum, and 2 patients had cheek scars in an unfavorable direction. The combination flap is a simple, single-stage procedure useful for reconstruction of heminasal and lateral wall defects. This technique is easily reproducible and provides consistently good results.

Use of a helical composite free flap for alar defect reconstruction with a supermicrosurgical technique.

The highly contoured nature of the nose and the abundant free margin makes it especially difficult to reconstruct. In this report, we describe the use of a new helical rim free flap technique for the reconstruction of full-thickness nasal alar defects via supermicrosurgery. Briefly, after a wide excision with a margin of 0.7 cm, an alar defect with a size of 1×1×0.5cm was obtained, which included the full thickness of the skin, mucosa, and lower lateral cartilage. Vessel dissection was performed in a straightforward manner, starting from the incision margin for flap harvest, without any further dissection for reach the greater trunk of the superficial temporal artery. The flap was inset in order to match the contour of the contralateral ala. We closed the donor site via rotation and advancement. No donor site morbidity was observed, despite the presence of a small scar that could easily be covered with hair. The alar contour was satisfactory, and the patient was satisfied with the results. The supermicrosurgical technique did not require further dissection to identify the vessels for anastomosis, leading to better cosmetic outcomes and a reduced operating time.

Principles of Reconstruction After Mohs Surgery

Reconstruction of cutaneous defects is a key component following completion of extirpative surgery, with a primary aim of restoring form and function to sensitive regions of the face and scalp. We review flap physiology, defect analysis, and reconstructive options in the reconstructive ladder, and describe key principles in unit reconstruction. An overview of time-honored principles and techniques including healing by second intention, skin grafting, and local flaps is described. More contemporary techniques such as the use of perichondrium-cutaneous composite grafts, and multi-layered reconstruction of complex nasal defects including the use of forehead flaps are succinctly discussed. This concise review hopes to highlight key nuances in defect analysis, decision-making processes in choice of reconstruction, and considerations when performing reconstruction on various aesthetic units of the face and scalp.

Bending the Arc of the Trilobed Flap Through External Interlobe Angle Inequality.

The trilobed flap is a useful repair option for distal nasal defects. In certain cases, however, the placement of its quaternary defect may risk compression of the internal nasal valve or induction of ectropion. In this study, we propose a modified design of the trilobed flap, which uses unequal external interlobe angles. To present the design principles and results of our modified trilobed flap for the reconstruction of difficult distal nasal Mohs defects. Mohs defects of 26 patients were reconstructed (21 with long-term follow-up) using our modified trilobed flap over 1 year. Two independent masked raters graded postoperative photographs for alar symmetry and overall cosmesis. Median alar symmetry scores were excellent and overall cosmesis grades were between excellent and very good. The modified trilobed flap with unequal external angles offers an excellent option for reconstruction of Mohs defect of the distal nose that may not be well-suited for other repairs. Over 1 year, 21 modified trilobed repairs were performed with overall excellent outcomes.

Approach to Reconstruction of Nasal Defects.

The nose is the most central and anterior projecting facial feature. Therefore, the presence of a defect is easily noticeable to the untrained eye. Return of the defect to the original form is an achievable end goal of reconstruction, necessitating appropriate reformation of three-dimensional geometry, proper establishment of symmetry, and excellent color and texture match to the adjacent structures. Regarding its physiological importance, disruption of the normal function may cause respiratory obstruction and contribute to patient distress. To achieve successful repair, preoperative preparation must consider the location, the layers involved, and the size of the defect. Prompt and well-organized repair minimizes the occurrence of progressive necrosis and severe late-stage deformity. Here the authors provide a framework to approach various nasal defects and provide a review of the novel ideologies and techniques. The workhorse of nasal repair, the forehead flap, is discussed independently due to the breadth of innovation.

Cranially-based nasolabial flaps for the reconstruction of nasal surgical defects.

BackgroundCranially-based nasolabial flaps are a good alternative for the reconstruction of nasal defects.MethodsA cranially-based nasolabial flap was used in 18 patients to reconstruct defects of the nose from 2010 to 2016, and the long-term results are presented in this report.ResultsFifteen of the flaps completely survived. All the patients had a bulky appearance, but they did not want to undergo a second operation for cosmesis. The dissection of the flap took approximately 20 minutes, and the total operation lasted for 1 hour. The patients were hospitalized for 1–7 days, and the postoperative follow-up period was 1–28 months (mean, 17 months).ConclusionsThe cranially-based nasolabial flap possesses all the advantages of the traditional forehead flap, and can safely be used in selected cases.

The Use of a Combined Local Flap for Reconstructing a Complex Nasal Defect.

The main goals of reconstruction of nasal defects are to restore the topographic subunit outline, thereby maintaining the aesthetic three-dimensional facial contours and more importantly ensuring a patent airway. Wide excision of tumours of the external nose can at times result in complex defects causing significant facial disfigurement and this poses a significant reconstructive challenge. Nasal reconstruction with only micro-vascular free flaps can at times produce poor aesthetic outcomes as distant skin often appears as a mismatched patch within the surrounding normal facial skin. We describe a novel technique for external nose reconstruction using a combination two well described local flaps, superiorly based nasolabial flap alongside a paramedian forehead flap.

Nasal reconstruction of multiple nasal subunits skin defect using an “island flap” after oncological surgery for basal cell carcinoma

Nasal reconstruction of multiple nasal subunits skin defect using an “island flap” after oncological surgery for basal cell carcinoma

Repairing partial nasal defect with different strategies

Objective Proper selection of reconstruction method is the key point to get a successful result in nasal reconstruction. The purpose of the article is to evaluate the results of repairing the partial nasal defect with different surgical strategies. Methods Different surgical methods were used according to the area and type of nasal defects of nasal defects, the different sub-unit of nasal defects and the different tissue damage levels. Local skin flaps, auricular composite tissue flaps, nasolabial skin flaps and superficial temporal artery pedicle flaps were used in these patients. Results 23 cases suffering from partial nasal defects were repaired with flaps or tissue graft, including 4 auricular composite tissue flap, 5 nasolabial skin flap, 3 forehead island flap with a pedicle of superficial temporal vessels, 7 local flap, and 1 skin graft. After 5-16 months of follow-up, the color and texture around the nose were basically consistent, the appearance of nose was satisfactory, and the postoperative effect turned out fine. Conclusions The method of surgical reconstruction of partial nasal defects should be considered carefully according to the area of nasal defects, sub-unit of nasal defects and the different tissue damage levels. Key words: Nasal defect; Reconstruction; Flap

Multiple options of reconstruction of nasal ala defects with aesthetic outcome

Multiple options of reconstruction of nasal ala defects with aesthetic outcome

Reconstruction of the Intranasal Lining.

Reconstruction of full-thickness nasal defects has been the subject of surgical inquiry and innovation for over 2,000 years. The replacement of the internal nasal lining is a critical feature of complex nasal reconstruction. Successful reconstruction can prevent cicatricial contraction, external distortion, and internal stenosis. An array of reconstructive possibilities has been described, including cutaneous, mucosal, and fascial options. The challenge to the reconstructive surgeon is to select the repair that maximizes internal stability, while maintaining a patent nasal airway, minimizing morbidity, and meeting patient expectations. This article reviews the options available for the reconstruction of the intranasal lining.

Nasolabial Perforator Flap for One-stage Reconstruction of Nasal Defects.

Background:The excellent freedom of movement and range of this flap when based on a the nasolabial perforator flap have not been sufficiently explored. In this study, along with demonstrating the other key advantages of this flap over its traditional counterpart, we will endeavour to fill these lacunae in the available literature.Materials and Methods:From February 2009 to February 2012, twenty patients with nasal defects were repaired with a nasolabial perforator flap in the Department of Plastic and Cosmetic Surgery at Sir Ganga Ram Hospital, New Delhi. Of these, two patients (10%) underwent the procedure bilaterally. Thus, a total of 22 nasolabial perforator flap procedures were carried out. Prospectively, collected clinical records and data of each patient were retrospectively retrieved and reviewed to study the nasal defect and surgery done.Results:All the twenty (100%) patients had good functional and aesthetic outcome. All patients who had nasal stenosis preoperatively had very good improvement in the patency of the nasal passages, breathing and nasal blockage with complete recovery of symptoms. The patients were entirely satisfied with the functional recovery.Conclusions:The reliability and versatility of the nasolabial perforator flap exceed its recognised application in reconstruction of nasal defects and it must form a part of every plastic surgeon's armamentarium.

Reconstruction of nasal defects with local flaps

Reconstruction of nasal defects with local flaps

Reconstruction of Subtotal Nasal Defect with Radial Forearm Free Flap and Forehead Flap: A Case Report

Reconstruction of Subtotal Nasal Defect with Radial Forearm Free Flap and Forehead Flap: A Case Report