[Treatment of nasal saddle-back deformities using a median naso-frontal five-point star flap]

Severe saddle-back deformities of the nose require reconstructive surgery using bone grafts, often in association with tegmental tissue when the point of the nose is retracted. To diminish the inconveniences of the multiple techniques proposed, the procedure employed involves the use of a mesiofrontal, inter-eyebrow sliding graft with its superior point in VY, and with a pedicle consisting of the remaining tissue of the nasal ridge. Four triangular flaps arise from the edges of this flap, their apices being external and supra- or infra-eyebrow in position. They are transposed downwards for one stage, into two infra-eyebrow and infra-canthal zones. These will fill the raw surfaces to allow the bone graft to be applied. Loss of frontal substance is compensated by a VY above and by apposition of the edges laterally. The lateral flaps replace the two peri-orbital losses of substance, and give a sufficient amount of tissue on either side of the nasal ridge to enable the bone graft to be covered without excessive tension. This technique presents the advantages of being performed as a one-stage operation and of producing less scarring. The flap has the shape of a star with five branches and is termed a christmas tree flap; the pedicle is situated below and forms the roots of the tree.