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The Folded Ulnar Forearm Flap for Nasal Reconstruction
Yen-Chang Hsiao1, Jung-Ju Huang, Jonathan A Zelken
1Taipei, Taiwan; Khartoum, Sudan; and Hamburg, Germany From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; the Department of Surgery, Faculty of Medicine, University of Khartoum; and the Department of Plastic and Reconstructive Surgery, Agaplesion Diakonie Klinikum.
The ulnar forearm flap offers a safe and reliable option for nasal reconstruction, providing superior aesthetic outcomes. This flap, utilizing a novel folding technique, achieves excellent functional and cosmetic results.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Otolaryngology
Background:
- Free flaps are essential for extensive nasal defect reconstruction.
- The radial forearm flap, while common, has drawbacks including hair growth and unfavorable donor-site aesthetics.
- The ulnar forearm flap is an underutilized option with significant aesthetic advantages for nasal reconstruction.
Purpose of the Study:
- To describe the authors' experience using the ulnar forearm flap for nasal reconstruction.
- To evaluate a novel tubular folding technique for staged nasal reconstruction with the ulnar forearm flap.
Main Methods:
- Ten nasal reconstructions were performed using the ulnar forearm flap between December 2010 and April 2015.
- The flap was designed along the ulnar vascular axis and tubularized twice to form nasal passages.
- A folding technique was employed for coverage, with caudal edges sutured to form alae and columella.
Main Results:
- Satisfactory aesthetic and functional outcomes were achieved in all patients after an average of 6.4 operations.
- Complications included partial alar lining necrosis (salvaged), chondritis (managed conservatively), and one case of severe chondritis requiring re-reconstruction.
- Average follow-up was 25.2 months, with reconstructive duration averaging 11.1 months.
Conclusions:
- The ulnar forearm flap is a safe and reliable choice for nasal reconstruction, offering superior donor-site cosmesis.
- The tubular folding technique facilitates vascularized framework construction in the same stage.
- Careful planning and refinement enable excellent aesthetic and functional results in nasal reconstruction.
