Reconstruction Of Nasal Tip Defects Research Articles

Paramedian Forehead Flap for Reconstruction of Nasal Tip Defect.

Paramedian Forehead Flap for Reconstruction of Nasal Tip Defect.

Reconstruction of nasal ala and tip following skin cancer resection.

BackgroundDefects of the nasal ala and tip have a complex three-dimensional structure that makes them challenging to reconstruct. Many reconstructive options have been described for nasal ala and tip defects, ranging from primary closure to local flaps and skin grafts. However, it is difficult to determine which method will yield the best cosmetic results in each individual case. Thus, the purpose of this study was to determine which surgical procedures for reconstructing defects of the nasal ala and tip have better cosmetic results.MethodsFrom 2008 to 2018, 111 patients underwent surgery to reconstruct skin defects after resection of skin cancer in the nasal ala or tip. Their charts were reviewed to obtain data on age, sex, surgical location, size of the defect, surgical method, and cosmetic results using a visual analog scale (VAS).ResultsFor nasal ala reconstruction, the most commonly used surgical technique was the nasolabial flap (n= 42). This method also had the highest VAS score (7/10). The most commonly selected surgical method for nasal tip reconstruction was the bilobed flap (n= 13), and bilobed flaps and primary closure had the highest VAS score (7/10).ConclusionNasolabial flaps showed excellent cosmetic results for the reconstruction of nasal ala defects, while primary closure and bilobed flaps yielded excellent cosmetic results for the reconstruction of nasal tip defects.

The Axial Frontonasal Flap for Nasal Tip Defect: A Single Centre Experience.

ObjectivesSkin defects of the nose can be a surgical challenge for facial plastic surgeons. Often, invasive surgery of the nose is accompanied by aesthetic issues for the patient. Hence, following invasive surgery of the nose, a reconstructive procedure should be performed to correct the morphological and aesthetic issues. This can help to restore the aesthetic features of the nose. Of the several reconstructive procedures available for nasal tip defects, the axial frontonasal flap is regarded as a good option for nasal tip reconstruction. Herein, we describe our experience with the axial frontonasal flap for the reconstruction of nasal tip defect in 15 patients. We also would specify the indications for the use of this flap and describe in detail the surgical technique.Materials and MethodsThis was a retrospective study of 15 patients who underwent reconstruction of nasal tip defect with an axial frontonasal flap between 2012 and 2015. In all the patients, the defects were located on the nasal tip. The measurement of the nasal tip defect in all the cases was ≥ 1.4 cm in their shortest diameter. The patients were followed up to 12 months after surgery.ResultsThe axial frontonasal flaps for all the patients survived completely without any complications. In all patients, the follow-up surgical result was rated as good or excellent by the patients and surgeons.ConclusionsBased on the results of our review of cases, we highly recommend the axial frontonasal flap as an option for the reconstruction of nasal tip defects measuring ≥ 1.4 cm in diameter.

Supermicrosurgical reconstruction of nasal tip defects using the preauricular reversed superficial temporal artery flap

Microsurgical reconstruction of nasal tip defects is difficult to achieve. The free composite auricular flap allows for repair in a one-stage procedure. However, anastomosis to the recipient facial artery is often complicated because of its variable anatomy and the need for a vessel graft. In this study, we describe our experience using the alar artery and angular vein as recipient vessels for direct super microsurgical anastomosis. From February 2004 to December 2015, thirty-two patients with different degrees of full-thickness multi-subunit nasal tip defects were included in this study. The superficial temporal vessels, alar artery, and angular vein were marked preoperatively by ultrasound detection. The preauricular reversed superficial temporal artery flap was harvested and transferred to the nasal tip defect region as a free flap using a supermicrosurgical technique. Patient pictures were taken before surgery and at 1, 3, and 6 months of follow-up. Outcomes and complications were recorded and analyzed. Moreover, a postoperative patient satisfaction survey was performed. The reversed superficial temporal artery flap was used in a total of 32 patients for the reconstruction of nasal tip defects in a one-stage procedure. In all cases, the alar artery and angular vein showed no anatomical variations and were used as recipient vessels. The size of the harvested preauricular flap size was 2.5×2.0 to 4.0×3.6cm2, and the average flap size was 3.6×2.7cm2. The length of the arterial pedicle was 4.0 to 6.7cm, 5.58cm on average. The length of the venous pedicle was 5.0 to 6.8cm, 6.21cm on average. Direct anastomosis was achieved in all patients, and in none of the cases, a vascular graft was needed. Donor sites were all closed primarily. Flap survival was complete, except for one case of vascular thrombosis, resulting in a 10% flap necrosis. Temporary hematoma was noted in one patient. The postoperative outcome showed excellent functional coverage and improved esthetic appearance. The average follow-up period was 12 months. The majority of patients (98.5%) rated their postoperative outcome as highly improved and improved. No late recurrence or other complications were seen in any of the patients. Twenty-two patients underwent a secondary debulking procedure of the flap for fine adjustment. Our results demonstrate that the alar artery and angular vein are suitable recipient vessels for the super microsurgical reconstruction of nasal tip defects. Surgical planning and procedure are facilitated by their reliable anatomy without the need for a vessel graft. This technique may offer wider applications by extension to other facial cutaneous 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.

Pincer Flap for Reconstruction of Nasal Tip Defects.

Reconstruction of the nasal tip defects is challenging because of variable contours of the region and the unique texture, thickness, color, and limited amount of available skin. There are several well-known local flaps for this purpose. Unfortunately, most of these flaps are suitable for small sized defects up to 2 cm in diameter. In this study, the authors are presenting a new flap for reconstruction of nasal tip and supratip defects larger than 2 cm in diameter. Pincer flap was used for reconstruction of nasal tip defects in 12 patients, between 2011 and 2014. The mean age was 67 (43-88). All patients had a basal cell carcinoma. Defects were located at the central nasal, lateral nasal, and supratip areas. All tumors were excised with safe margins. After the excision, defects were reconstructed with pincer flap in the same session. The mean follow-up period was 11 (6-18) months. There was not any flap loss. Infection and venous congestion was observed in 2 patients but the patient did not require any further surgical intervention, and healed with local and systemic antibiotherapy. No recurrence occurred and the outcome was aesthetically favorable. The authors concluded that pincer flap is reliable and may provide a single-stage reconstruction for the nasal tip defects larger than 2 cm and up to 3 cm in diameter.

Trilobed flaps for reconstruction of nasal tip defects

Objective To evaluate the performance of trilobed flaps for reconstruction of nasal tip defects. Methods Totally, 23 patients with nasal tip defects after tumor resection were enrolled into this study. Skin defects varied from 1.5 cm × 1.5 cm to 2.5 cm × 2.5 cm in size. According to the location and size of skin defects, trilobed flaps were designed, and the angle between two lobes ranged from 45° to 50°. The size of the first lobe was approximately equal to that of the skin defect, while the size of the second and third lobes decreased successively. During flap design, the integrity of nasal subunits was sufficiently considered, and the incision lines were placed along the boundary lines of the nasal subunit as far as possible, so as to conceal the incision scar with natural skin folds. Results After the operation, skin flaps survived with primary healing of incisions in all the patients. After 6-24 months of follow up, the color, texture and thickness of flaps were similar to those of their surrounding skin, and incision scars were inconspicuous. No malformation occurred in the nasal ala, nostril, nasal columella or surrounding organs, and satisfactory nasal appearance and function were achieved. Conclusion Trilobed flaps can be used to effectively repair relatively large skin defects of the nasal tip with satisfactory nasal appearance and function. Key words: Carcinoma, basal cell; Surgical flaps; Nasal surgical procedures

Application of modified Rintala flap in nasal tip reconstruction

IntroductionFor nasal tip reconstruction, we must consider optimal results including color match, good tissue coverage, excellent flap viability, and good aesthetic result. MethodsIn this study, 25 patients who had nasal tip skin tumors were included, and reconstruction of the defects by dorsal nasal advancement flap (Rintala) was done. The advantages and disadvantages of the Rintala flap were described for all patients with nasal tip basal cell carcinoma (BCC). All patients filled out the consent form before reconstruction and tumor surgery. ResultsIn this study, 25 patients (11 women and 14 men) ranging from 25 to 72 years old (mean, 53 years) underwent operation with dorsal nasal advancement flap (Rintala). Reconstruction of nasal tip defects after complete tumor excision was done with free margin. After sedation analgesia, we used bilateral parallel incision in both sides of the nasal sidewalls from corner to glabellar region; Burow triangles are excised bilaterally in lateral to the base of the flap. ConclusionsIn case of midline tip defects with 1.5 to 2.5 cm in diameter, a modified Rintala flap is a good choice for reconstruction of this difficult area. This is a superiority-based randomized flap that makes an aesthetic nasal tip after tumor excisions without any fear from ischemia or necrosis of the flap.

Crescentic Nasojugal Flap for Nasal Tip Reconstruction

Carcinomas of the tip of the nose are very common, and the nasal tip defect is one of the most challenging subunit to reconstruct. There are numerous available procedures for the reconstruction of the tip of the nose. We have developed a flap for the management of a tissue loss from the tip of the nose and report the use of this flap for 11 patients. The purpose of this presentation is to report a refinement of a nasojugal flap for the reconstruction of a nasal tip defect. The flap we describe has the characteristic of excising the dog-ear, created by the movement of the flap, in a crescent shape of skin in the perialar area, allowing the mobilization of the skin of the lateral surface of the nose and cheek. Eleven patients presenting tissue loss from the tip of the nose after excision of carcinoma underwent surgery using the flap. The flap described constitutes a good alternative for reconstruction of nasal tip defect, up to 2 cm of diameter, with excellent aesthetic results. Numerous flap options are available to reconstruct tissue loss from the tip of the nose. The nasojugal flap we describe, due to its great reliability, yields excellent functional and cosmetic results, and we believe that it is a valuable alternative to other techniques of reconstruction for defect of the nasal tip. For the 11 patients who underwent surgery with this flap, no major complication was reported. The aesthetic result was never compromised, and the scars result was very satisfactory.

A superiorly based, externally pedicled nasolabial flap for the repair of complex nasal tip defects

The reconstruction of nasal tip defects can often be quite challenging. For small or superficial defects, primary closure, secondary healing or skin grafting are common options. For larger, full thickness defects with exposed cartilage, local or distant flaps are usually required. An experience using a superiorly based, externally pedicled nasolabial flap for full thickness nasal tip defects in six patients is described. The reconstruction is performed in three stages, allowing for aggressive thinning and debulking of the flap at the time of final insetting. The flap has good excursion with a wide arc of rotation, allowing it to be used in a variety of complex nasal tip defects. Patient satisfaction with the eventual outcome has been excellent.

Reconstruction of Nasal Tip Defects by Dorsonasal V-Y Advancement Island Flap

The nasalis musculocutaneous sliding flap developed by Rybka and the myocutaneous axial flap with lateral pedicle reported by Martire and associates are extremely useful for reconstruction of the nasal tip and surrounding area, respectively. We have modified the method of Martire and associates into an operative procedure that can be easily employed. By confirming the blood flow of the lateral nasal artery preoperatively by Doppler probing, the lateral pedicle of the flap was made smaller to facilitate mobilization of the flap. Furthermore, this flap could be made into a reversed-flow flap when indicated.

Full-thickness skin graft reconstruction of nasal tip defects.

Full-thickness skin graft reconstruction of nasal tip defects.

Reconstruction of Nasal Tip Defect

SummaryOur experience with nasal tip reconstructions using angular mid line forehead flap is presented. This flap has been shown to be better because it provides additional length.