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Simultaneous free flap and forehead flap for nasal reconstruction
Cheng-I Yen1, Huang-Kai Kao1, Chun-Shin Chang1
1Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Microsurgery
|February 10, 2023
Summary
This study combined free tissue transfer for nasal lining with a paramedian forehead flap for skin coverage in complex nasal reconstruction. This single-stage approach offers a potentially shorter, effective solution for total or subtotal nasal defects.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Otolaryngology
Background:
- Reconstructing total or near-total nasal defects requires addressing three distinct tissue layers.
- Traditional methods often involve staged procedures, such as using fasciocutaneous free flaps for lining and separate forehead flaps for skin coverage, leading to prolonged treatment times.
- This study investigates a combined, single-stage approach for complex nasal reconstruction.
Observation:
- Ten patients with total or subtotal nasal defects underwent simultaneous reconstruction using free flaps (medial sural artery perforator, anterolateral thigh, or radial forearm) for lining and paramedian forehead flaps for skin coverage.
- Functional outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) score, and aesthetic results were evaluated by surgeons and laypersons.
- The average time between the initial surgery and forehead flap division was 5.7 months, with a shorter interval of 2.2 months for uncomplicated cases.
Findings:
- One free flap experienced partial necrosis due to infection; otherwise, the combined approach yielded satisfactory results.
- The average follow-up period was 29.6 months.
- The mean NOSE score was 5.9, indicating improved nasal airflow, and the average aesthetic score was 4.1 out of 5.
Implications:
- Combining preliminary free tissue transfer for nasal lining with a paramedian forehead flap in a single stage can potentially expedite the complex nasal reconstruction process.
- This integrated surgical strategy may offer a more efficient and effective solution for achieving both functional and aesthetic restoration in patients with extensive nasal defects.
- The findings suggest this combined technique is a viable option for improving patient outcomes in challenging reconstructive scenarios.
