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

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

Excellency of Converse Scalping Forehead Flap for Reconstruction of External Nasal Soft-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.

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

<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>

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

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.