Reconstruction of Full-Thickness Nasal Defect Following Radiation Therapy for Nasal Lymphoma

Reconstruction of full-thickness nasal defects after radiotherapy is challenging because of poor tissue vascularity and impaired wound healing. We report a 54-year-old man with a full-thickness nasal defect after chemoradiotherapy for extranodal natural killer/T-cell lymphoma and failure of nasolabial flap reconstruction. Salvage reconstruction was performed using a multistage approach. After extensive debridement, an intentionally oversized thoracodorsal artery perforator flap was transferred and folded to reconstruct both the intranasal lining and external coverage. Structural support was subsequently restored with an L-shaped iliac bone graft, with additional auricular cartilage grafting for alar reconstruction. Further staged procedures were performed to refine the contour and correct the lower eyelid. At 3.5 years after the initial free flap transfer, stable nasal form, satisfactory facial symmetry, and high patient satisfaction were maintained. This staged strategy may provide a reliable option for complex full-thickness nasal reconstruction in previously irradiated fields.