Nasalis myocutaneous island pedicle flap for nasal reconstruction – a case series

Abstract Postburn total nasal reconstruction associated with face burns is challenge to all reconstructive surgeons. The local tissue flaps for reconstruction is virtually out of options, forcing surgeons to opt for distant tissues for nasal reconstruction. Here in, we have described the use of distally based radial artery perforator flap for total postburn nasal reconstruction which has not been described for nasal reconstruction. The anatomy and technique of the flap and case series is presented in this report. Two cases of total nasal reconstruction using the distally based radial artery perforator flap are presented, one case post thermal burn and another post chemical burn. Radial artery distal perforator-based pedicled flap is a versatile option for nasal reconstruction especially when there is a paucity of unscarred skin in loco regional options.

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Evaluating the Success of Lateral Pedicle Flap Using Root Coverage Esthetic Score – A Case Series

Review Article ◽

10.53064/jrad.2021.12.5.46 ◽

2021 ◽

Vol 12 (5) ◽

pp. 278-281

Author(s):

C. Hemachandra Babu ◽

Asma Naaz ◽

S. Vijayashanthi ◽

Vijendar Bhukya

Keyword(s):

Case Series ◽

Root Coverage ◽

Pedicle Flap

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Reconstruction of midface defect with temporalis myofascial pedicle flap: a review and case series

MOJ Surgery ◽

10.15406/mojs.2021.09.00186 ◽

2021 ◽

Vol 9 (1) ◽

pp. 15-19

Author(s):

Fawzia Mohamed Afrid Butt ◽

Symon Wangombe Guthua

Keyword(s):

Case Series ◽

Pedicle Flap

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Nasal Reconstruction Using a Myocutaneous Island Pedicle Flap Based on the Nasalis Muscle With Bilevel Undermining

Annals of Plastic Surgery ◽

10.1097/sap.0000000000002621 ◽

2021 ◽

Vol 86 (2) ◽

pp. 171-174

Author(s):

Farzad R. Nahai ◽

Diamondis J. Papadopoulos ◽

John Paul Papadopoulos ◽

Paris Thatos ◽

Iviensan F. Manalo

Keyword(s):

Nasal Reconstruction ◽

Pedicle Flap ◽

Nasalis Muscle

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Nasal reconstruction with the cheek island pedicle flap

Journal of the American Academy of Dermatology ◽

10.1016/s0190-9622(96)90684-2 ◽

1996 ◽

Vol 35 (4) ◽

pp. 580-587 ◽

Cited By ~ 20

Author(s):

Scott W Fosko ◽

Leonard M Dzubow

Keyword(s):

Nasal Reconstruction ◽

Pedicle Flap

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Microsurgical Reconstruction of the Nose: The Aesthetic Approach to Total Defects

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1719047 ◽

2020 ◽

Author(s):

Valentina Pinto ◽

Elisa Antoniazzi ◽

Federico Contedini ◽

Marco Pignatti ◽

Angelo Pizzigallo ◽

...

Keyword(s):

Surgical Techniques ◽

Case Series ◽

Current Approach ◽

Nasal Reconstruction ◽

Forehead Flap ◽

Radial Forearm ◽

The Aesthetic ◽

Skin Coverage ◽

Alt Flap ◽

Nasal Defects

Abstract Background Reconstruction of complex defects involving nose and close facial units represents an aesthetic and functional challenge. Restoring satisfactory nasal shape, combining aesthetic, nasal function and patent airways is mandatory. In this paper, we describe our approach to total nose defects and we report our 20-year experience in microvascular nose reconstruction.Clinical cases are shown to illustrate different surgical techniques and the evolution of our approach. Methods Nasal reconstruction procedures were performed on 21 patients between 2000 and 2020 using the radial forearm flap (RFF) or anterolateral thigh (ALT) flap. Reported reconstructions included total/subtotal nasal defects, caused by cancer resections. The key point of our approach is the expanded forehead flap for skin coverage. Reconstruction is completed by cartilage grafts to restore nasal framework and to shape nasal tip. Ancillary procedures were needed in some cases to optimize aesthetic outcomes. Results Twenty-one patients completed the multistage nasal reconstruction. The RFF flap was used in 56% of the cases (n = 11), while the ALT flap was used in 44% (n = 10) of our case series. No difference has been detected in the number of reconstructive stages required to achieve the final result comparing RFF and ALT reconstruction (3.3 vs. 3.1 reconstructive steps). Ancillary procedures were performed in 7 patients. Conclusion Microvascular tissue transfer plays a key role in full-thickness nasal defects restoration. Comparing the two groups, both the RFF and ALT are effective and reliable options in lining reconstruction, although with different indications. Expanded forehead flap, combined to free cartilage graft, is our gold standard to provide external skin coverage to rebuild the nasal framework. According to our current approach, accurate preoperative planning, supported by modern technologic tools, multistage reconstruction, and ancillary procedures are useful to accomplish satisfactory functional and aesthetic outcomes.

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The V-to-Y Advancement Flap for Distal Nasal Reconstruction: Our Experience With 39 Patients

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475418761043 ◽

2018 ◽

Vol 22 (4) ◽

pp. 411-414

Author(s):

Ryan B. Thorpe ◽

Rajiv I. Nijhawan ◽

Divya Srivastava

Keyword(s):

Medical Center ◽

Advancement Flap ◽

Single Stage ◽

Medium Size ◽

Nasal Reconstruction ◽

Pedicle Flap ◽

Flap Design ◽

Cosmetic Outcomes ◽

Advancement Flaps ◽

Nasal Defects

Background and Objective: The V-to-Y advancement flap, also known as the island pedicle flap, is a single-stage repair option that can be used for defects on the distal nose. We report our experience using this flap for nasal defects following Mohs micrographic surgery, as well as describe optimal patient selection and flap design. Materials and Methods: A retrospective review was conducted of all patient charts and operative photographs of nasal V-to-Y advancement flaps performed over 6 years at the Universtiy of Texas Southwestern Medical Center. Charts were reviewed for age, sex, tumour type and location, defect size, anticoagulation, immunosuppression, postoperative complications, revisions, and outcomes. Results: Thirty-nine patients with defects ranging from 0.7 to 1.7 cm in size (median of 1 cm) were included. Most defects involved the inferior, paramedian nose, and after accounting for 7 postrepair interventions on 6 (15%) patients, 38 (97%) patients were noted to have good to excellent cosmetic outcomes while 1 patient experienced a persistent trapdoor effect. Conclusion: The V-to-Y advancement flap is an excellent single-stage option that can reliably provide good to excellent cosmetic results when used to repair small- to medium-size sized defects on the distal half of the nose.

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Pedicle flap reconstruction for treatment of infected median sternotomy wounds after cardiac surgery in overweight and obese patients: proposal of a management algorithm based on a case series analysis

BMC Surgery ◽

10.1186/s12893-021-01451-5 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Marios Papadakis ◽

Afshin Rahmanian-Schwarz

Keyword(s):

Cardiac Surgery ◽

Donor Site ◽

Case Series ◽

Normal Weight ◽

Postoperative Outcomes ◽

Flap Reconstruction ◽

Pedicle Flap ◽

Series Analysis ◽

Management Algorithm ◽

Duration Of Surgery

Abstract Background A relationship between obesity and adverse outcomes in patients with post-sternotomy wounds undergoing pedicle flap reconstruction is not well-documented. In this study, we present a single-centre retrospective case series analysis of early postoperative outcomes of patients with infected post-sternotomy wounds undergoing pedicle flap reconstruction. We also propose a management algorithm for such patients, based on BMI and wound width. Methods We retrospectively analyzed all patients, who underwent pedicle flap reconstruction for major sternal wound infections after sternotomy for cardiac surgery in a tertiary hospital in Germany during a 5-year period. Exclusion criteria included patients younger than 18 years of age and patients with BMI < 18.5 kg/m2. Patients were divided into 2 groups according to BMI: normal-weight (NW; BMI < 25 kg/m2) and overweight/obese (OB/OW; BMI > 25 kg/m2). Both groups were compared in terms of preoperative parameters and early postoperative outcomes. Preoperative parameters included demographics, wound bacteria and comorbidities. Postoperative outcomes included duration of surgery time (from incision to skin closure), transfusion requirement (during surgery and entire hospital stay), onset of flap and donor-site complications, length of stay and 30-day mortality. We employed the two-tailed t-test to compare continuous variables and the two-sided Fischer’s exact test to compare categorical variables. Statistical significance was set at p < 0.05. Results The total sample consisted of 48 patients. Overall mean BMI was 28.4 (6.1) kg/m2. Mean age was 67 (12) years. The study group consisted of 28 patients with BMI > 25 kg/m2, who were compared with 20 normal-weight patients. There was a significant difference amongst both groups regarding duration of surgery (120 vs. 174 min, p < 0.05). Donor-site complications requiring intervention were observed in 30% of patients in both groups. Flap-related complications were recorded in 16 (57%) cases in the study group and 7 cases in the control group (35%, p = 0.15). Conclusions We conclude that wound width and BMI can aid the decision-making process for patients with infected sternal wounds after cardiac surgery requiring pedicle flap reconstruction. However, in our case series analysis, OB/OW patients were not found to be at statistically significantly increased risk for worse postoperative outcomes, but were associated with a longer duration of surgery.

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