scholarly journals Is reconstruction of composite defects of nose and cheek following tumor excision utilizing subunit principle the best?

2021 ◽  
Vol 7 (5) ◽  
pp. 721
Author(s):  
Viresh Arora ◽  
Faisal Ashfaq ◽  
Atif Rafique
Keyword(s):  
Wound Dehiscence ◽  
Advancement Flap ◽  
Nasal Reconstruction ◽  
Full Thickness ◽  
Lateral Migration ◽  
Forehead Flap ◽  
Nasal Defect ◽  
Alar Retraction ◽  
Simultaneous Reconstruction ◽  
Nasal Defects

<p class="abstract"><strong>Background:</strong> Composite defects of nose and cheek are best stage reconstructed with separate nose and cheek flaps to recreate a blended nose-cheek junction, achieved by cheek advancement flap for cheek and forehead flap or local grafts for the nasal defect. This article analyses whether reconstruction of defects utilizing well-known subunit principle is cosmetically the best?</p><p class="abstract"><strong>Methods:</strong> Case records of fifteen patients of nasal cancers extension into the cheek from January 2011 to December 2015 were analyzed retrospectively.</p><p class="abstract"><strong>Results:</strong> Out of fifteen patients 8 were men and 7 women, two patients had SCC, rest had BCC. Average size of defect was 4.5 cm. Modified Imre’s cheek advancement flaps was used in all to reconstruct cheek defects while paramedian forehead flap was used for nasal reconstruction in 13 patients, skin graft and nasal advancement flap in one each. Eight patients underwent single stage reconstruction while seven with full thickness nasal defects had a delayed reconstruction. 13 patients rated their final appearance as satisfactory, while surgeon rated 12 patients with well-blended nose-cheek junction as satisfactory and lateral migration of junction being unsatisfactory. Alar retraction was observed in two patients with full thickness nasal defects. Two patients who underwent inner nasal lining reconstruction developed wound dehiscence while simultaneous reconstruction of nose and cheek was performed.</p><p class="abstract"><strong>Conclusions:</strong> Subunit principle application for composite nose and cheek results in symmetrical nose-cheek junction and appears excellent technique in achieving a satisfactory aesthetic outcome. Optimal results in full thickness nasal defects are achieved where reconstructing is delayed.</p>

Composite Cartilage-osseous-mucosal Nasoseptal Flap for Reconstruction after Near Total Rhinectomy

2020 ◽  
Vol 130 (1) ◽  
pp. 98-103
Author(s):  
Karthik S. Shastri ◽  
Yufan Lin ◽  
Jessica Scordino ◽  
Carlos D. Pinheiro-Neto
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Septal Cartilage ◽  
Nasal Reconstruction ◽  
Full Thickness ◽  
Nasoseptal Flap ◽  
Nasal Defect ◽  
Skin Envelope ◽  
Upper Lateral Cartilage ◽  
Nasal Defects

Background: Reconstruction of full thickness nasal defects usually requires different donor sites for the external skin envelope, structural elements, and internal nasal lining. In this paper we present a novel single site method for dual inner lining and skeleton repair for full thickness nasal defects with a composite nasoseptal flap and extended pedicle dissection. Methods: A 72-year-old male presented with a T4b melanoma involving the nasal dorsum and left upper lateral cartilage. Following full thickness resection, reconstruction was performed with a nasoseptal flap (NSF) with attached septal cartilage and vomer in conjunction with a paramedian forehead flap. Extended pedicle dissection into the pterygopalatine fossa allowed the NSF to fully cover the defect. Results: The nasal defect was fully corrected. There was no evidence of flap compromise or nasal valve stenosis at 1 month, 2 month, and 1 year follow-up visits. Conclusions: We present here the first successful application of a composite cartilage-osseous-mucosal NSF for multilayered nasal reconstruction. In appropriate patients, this technique may obviate the need for flaps or grafts from extranasal sources, limiting donor site morbidity.

scholarly journals Excellency of Converse Scalping Forehead Flap for Reconstruction of External Nasal Soft-Tissue Defects

2021 ◽  
Vol 29 (1) ◽  
pp. 43-47
Author(s):  
Gaurab Ranjan Chaudhuri
Keyword(s):  
Soft Tissue ◽  
Venous Malformation ◽  
Nasal Reconstruction ◽  
Soft Tissue Defects ◽  
Forehead Flap ◽  
Nasal Defect ◽  
External Nose ◽  
Post Traumatic ◽  
Nasal Defects ◽  
Tissue Defects

Introduction   Reconstruction of external nasal defects poses a challenge for the plastic surgeons. The scalping forehead flap, first described by Converse in 1942 is a versatile technique for subtotal and total external nasal reconstruction. The flap is extremely reliable with robust vascularity and provides excellent colour and texture match for the external nose with minimal donor-site morbidity.   Materials and Methods In this series, eleven patients with external nasal soft-tissue defects (post traumatic and post excisional) were reconstructed with scalping forehead flap; among them four presented with congenital naevus, three with post-traumatic external nasal defect, two presented with basal cell carcinoma, and two with arterio-venous malformation. The age of the patients ranged between 24 and 67 years; eight male and three female patients were included in this study. Among them three had comorbidities like diabetes mellitus and/ hypertension. Results All the flaps survived nicely. I didn’t face any complication in any of my patients. The external nasal defects were reconstructed with scalping forehead flap in two stages with an interval of three weeks in between. Conclusion The Converse scalping forehead flap is an excellent option in the armamentarium of plastic surgeons for subtotal and total nasal reconstruction because of its reliability, vascularity, and simplicity even in the era of microvascular free tissue transfer.

scholarly journals Local flap for reconstruction of nasal defect following excision of basal cell carcinoma of nose

2016 ◽  
Vol 9 (4) ◽  
pp. 208
Author(s):  
Hasib Rahman ◽  
Syed Farhan Ali Razib ◽  
Md. Abul Kalam Azad ◽  
M. A. Mannan ◽  
Md. Ashik Anwar Bahar ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Basal Cell ◽  
Local Flap ◽  
Nasal Reconstruction ◽  
Nasolabial Flap ◽  
Forehead Flap ◽  
Nasal Defect ◽  
Satisfactory Outcome

<p class="Abstract">Reconstruction of soft tissue at the nose following excision of basal cell carcinoma is always challenging, because of both functional and aesthetic importance of nose. The local flap is always preferable to skin graft as this produces “like with like” replacement, pliable cover and vascularized tissue over the skeletal framework. In this paper, we discussed six cases of nasal reconstruction with bilobed flap, forehead flap, and nasolabial flap. All flaps survived and the patients had satisfactory outcome.</p>

Forehead Flap for Nasal Reconstruction

2010 ◽  
Vol 3 (1) ◽  
pp. 13-15 ◽  
Author(s):  
JS Thakur ◽  
NK Mohindroo ◽  
DR Sharma
Keyword(s):  
Nasal Reconstruction ◽  
Skin Grafts ◽  
Full Thickness ◽  
Local Flaps ◽  
Wide Spread ◽  
Forehead Flap ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Granulomatous Diseases

Abstract Cancers and granulomatous diseases cause wide spread destruction of nose and reconstruction is a challenge to the surgeon. majority of the surgical defects after BCC excision can be reconstructed by full thickness skin grafts, bilobed and rhomboid local flaps but excision of SCC and large BCC lead to large surgical defects which need regional or distant flaps for reconstruction like median forehead flaps.

Choosing Appropriate Technique for Nasal Reconstruction in Challenging Cases of Panfacial Burn: Treatment Algorithm

2021 ◽  
Author(s):  
Mohammadhossein Hesamirostami ◽  
Leila Sarparast ◽  
Azar Radfar ◽  
Sami Hesamirostami ◽  
Ahmad Zaghi Hosseinzadeh ◽  
...  
Keyword(s):  
Treatment Algorithm ◽  
Composite Graft ◽  
Nasal Reconstruction ◽  
Forehead Flap ◽  
Burn Treatment ◽  
Short Nose ◽  
Nasal Defect ◽  
The Difference ◽  
Nasal Length ◽  
Selection Of

Abstract The Nose is one of the most challenging facial parts to reconstruct. Its asymmetries, defects, or disharmonies are easily noticeable. The complex contours, highlights, shadows, and special shape of its subunits makes nasal reconstruction more difficult in panfacial burn than that of nonburned ones. This retrospective study conducted at Zare Hospital. Twenty-five panfacial burn cases with nasal defect were studied from 2010 to 2019. Profile photos were manipulated by Photoshop. Based on the difference between the burn-related shortened nasal length and the expected photoshopped one, severity of the short nose was detected, and strategy of the surgery determined. Ten out of 25 cases with normal nasal length and projection, or mild short nose with minimal alar rim, tip and/or columellar defect underwent nasal reconstruction with skin and/or composite graft. Nine patients with normal nasal length or mild to moderate short nose but moderate to severe alar defect underwent reconstruction with turndown flap plus skin and/or composite graft. Pre-expanded forehead flap (n=1) and delayed scarred or skin grafted forehead flap (n=5) were used for six patients with severe short nose defect. There are several procedural alternatives for reconstruction of burn-related mild to moderate nasal deformity. For severe and deep pan facial burn, delayed forehead flap seems safe with acceptable color and texture harmony. Our designed algorithm could potentially improve selection of proper nasal reconstruction techniques and assist novice surgeons.

scholarly journals The use of folded melolabial interpolation flaps to repair full thickness distal nasal defects: A review of technique and results

2016 ◽  
Vol 1 (3) ◽  
Author(s):  
Eamonn Maher ◽  
Scott Walen ◽  
Ian Maher
Keyword(s):  
Cartilage Graft ◽  
Full Thickness ◽  
Forehead Flap ◽  
Common Site ◽  
Paramedian Forehead Flap ◽  
Surgical Teaching ◽  
Mucosal Lining ◽  
Cutaneous Flap ◽  
Surgical Options ◽  
Nasal Defects

<p>The nose is a common site for skin cancer and there are several surgical options available for reconstruction after excision. Traditional surgical teaching suggests that in the case of a partial full thickness defect involving the distal nose or ala, a paramedian forehead flap (PMFF) or an intranasal lining flap with free cartilage graft and additional cutaneous flap should be performed. However, each of these options comes with unique disadvantages. The incision and pedicle required for the PMFF can be unsightly and functionally limiting, while the intranasal lining flap is technically challenging and can obstruct the nostril. Herein, we review our experience with a two-stage folded-over melolabial interpolation flap (MLIF) to repair partial full thickness defects of the distal nose and ala in order to recreate the cutaneous covering, nasal rim, and inner mucosal lining.</p>

scholarly journals Alternative Procedure for One-Stage Nostril Reconstruction: A Case Report

2021 ◽  
Vol 3 (3) ◽  
pp. 158-161
Author(s):  
Iswinarno D. Saputro ◽  
Heri Noviana
Keyword(s):  
Case Report ◽  
Donor Site ◽  
Nasal Reconstruction ◽  
Defect Closure ◽  
Full Thickness ◽  
Nasolabial Flap ◽  
Nasal Cartilage ◽  
Nasal Defect ◽  
One Step ◽  
Turn Over

Closure of nasal defect remains a challenge for surgeons. There are several ways to do nasal reconstruction, including donor site for nasal reconstruction due to its vascularity that is superior to other areas. Methods: This is a case report of a 75-year old male patient with Squamous Cell Carcinoma on his left nostril who underwent wide excision. This action left a 4-cm defect, whilst the nasal septum remained intact. This defect closure was using V-Y advancement full thickness nasolabial flap in one step. This defect closure was using V-Y advancement full thickness nasolabial flap in one step. Results: The defect closure was performed with tum over local (nasobialis) flap from the left side of the nasal cartilage. The superiority of this flap, it is able to be performed bulking, so that closure with turn over local nasolabial flap has been a sole option in nostril reconstruction for decades, which gave very good cosmetic results. After being followed for 1 month after surgery, the flap was viable, the contour was well formed, the scar was minimal, and there was no respiratory disruption. The patient was satisfied by the results. Conclusion: Nasolabial turn over local flap can be used as an option to close a relatively wide nostril

scholarly journals Paramedian forehead flap for nasal tip reconstruction after Mohs surgery

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Felipe Bochnia Cerci
Keyword(s):  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Surgical Planning ◽  
Full Thickness ◽  
Mohs Micrographic Surgery ◽  
Forehead Flap ◽  
Micrographic Surgery ◽  
Nasal Tip ◽  
Paramedian Forehead Flap ◽  
Nasal Defects

<p>The paramedian forehead flap is a great option for restoring complex nasal defects. Its main indications are large and deep wounds located on the distal third of the nose (tip and ala). For full-thickness defects, the paramedian forehead flap may be used alone or in combination with other methods. We presented a patient with a nodular basal cell carcinoma on the nasal tip and collumela treated by Mohs micrographic surgery and repaired with a paramedian forehead flap. Prior to reconstruction, it is essential that surgical margins are completely evaluated and free of tumor. For optimal paramedian forehead flap results, adequate surgical planning and meticulous technique are imperative.</p>

scholarly journals Full-Thickness Skin Grafts and Quilting Sutures for the Reconstruction of Internal Nasal Lining

2020 ◽  
Vol 36 (03) ◽  
pp. 297-304
Author(s):  
PD Dr. med. Antoniu-Oreste Gostian ◽  
Dr. med. Matthias Balk ◽  
Dr. med. Achim Stegmann ◽  
Prof. Dr. med. Dr. h.c. Heinrich Iro ◽  
Prof. Dr. med. Jochen Wurm
Keyword(s):  
Skin Grafting ◽  
Free Flaps ◽  
Nasal Reconstruction ◽  
Skin Grafts ◽  
Full Thickness ◽  
Forehead Flap ◽  
Full Thickness Skin ◽  
Nicotine Abuse ◽  
Thickness Skin ◽  
Feasible Option

AbstractRestoration of the inner nasal lining is an essential factor in successful nasal reconstruction. Among various methods, free full-thickness skin grafting represents a readily available and feasible technique. A prerequisite for success is a secure and immobile fixation to the undersurface of the nourishing forehead flap. This retrospective study aims to evaluate the results of multiple quilting sutures to secure free full-thickness skin grafts for the reconstruction of the inner nasal lining in partial and extended nasal reconstruction. Between February 1, 2015, and December 31 2018, 16 patients underwent three-stage nasal reconstruction of all three layers using a forehead flap. All full-thickness free flaps were harvested from either the neck or inguinal area and fixated to the undersurface of the distal part of the forehead flap by multiple quilting sutures. All but one free skin grafts healed well (seven ♀; mean: 63 years; range: 52–81). Four patients developed minor complications that resolved completely through conservative treatment. One patient with a history of stroke, extensive nicotine abuse, and arterial hypertension developed flap necrosis that required two surgical revisions and ended up with a stenosis of the left nostril. The follow-up time averaged 18.4 months (range: 3–55 months). Multiple quilting sutures are an effective and feasible option to fixate full-thickness free skin grafts on the undersurface of the forehead flap for the reconstruction of the inner nasal lining. They are not associated with increased risks for necrosis and can be applied even to extended full-thickness nasal defects in selected cases.

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