The Role of Microsurgical Free Flap in Complex Nose Defect Reconstruction.

Area of Science:

• Plastic Surgery
• Microsurgery
• Biotechnology

Background:

• Nasal reconstruction presents challenges in restoring form, function, and aesthetics due to the nose's complex 3D structure.
• Simultaneous reconstruction of skin, skeletal support, and internal lining is crucial for composite nasal defects.

Purpose of the Study:

• To review a decade of clinical experience in nasal reconstruction at Chang Gung Memorial Hospital.
• To highlight advancements in reconstructive strategies for total or subtotal composite nasal defects using microsurgical free flaps.

Main Methods:

• Chronological review of 150 patient cases focusing on reconstructive strategy evolution.
• Emphasis on paramedian forehead flap (PFF) refinements, vascularized lining flaps (folded ulnar forearm flap, lower-extremity free flaps), and digital technologies (CAD, 3D printing).

Main Results:

• T-shaped PFF design improved columellar stability; lower-extremity flaps (ALT/MSAP) provided better airway support than FUFF.
• Digital planning with 3D printing significantly improved symmetry in heminasal reconstructions (p < 0.05).
• Simultaneous free flap and PFF transfer shortened treatment duration and reduced postoperative distress.

Conclusions:

• Complex nasal reconstruction requires a multimodal approach combining refined PFF techniques, appropriate free flap selection, and digital planning.
• Synergistic application of these techniques optimizes long-term aesthetic and functional outcomes.
• Expedited protocols enhance patient recovery and psychosocial well-being.