Temporoparietal Fascial Free Flap With Vascularized Helical Rim Component for Complex Nasal Reconstruction

Large nasal defects that cannot be addressed with forehead flaps often require microsurgical free flap-based reconstructions. The temporoparietal fascial flap (TPFF) has been described for nasal reconstruction, but no reports have shown the use of TPFF with helical rim cartilage for alar rim reconstruction in a single stage. Here, we describe a case of a TPFF harvested with vascularized helical rim skin and cartilage for reconstruction of a large nasal defect. An 8 × 10 cm nasal-cheek defect was reconstructed using a left TPFF with a composite helical rim for right ala restoration. The free flap was connected to the facial artery and vein via a right lesser saphenous vein graft in an arteriovenous loop configuration. Cadaveric cartilage grafts restored the underlying nasal framework. Finally, the flap was covered with a full-thickness skin graft. The postoperative course was unremarkable, and an aesthetic result was achieved. This study describes a free TPFF that incorporates auricular cartilage for the reconstruction of multiple nasal subunits in a single operation. With careful technique, a free TPFF that is harvested with a composite cartilage graft can enhance aesthetic outcomes and should be considered for patients with complete alar rim defects.