Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.

The authors demonstrated, for the first time, that hyperhomocysteinemia severely suppressed the microvasculature of skin flaps, as shown by increased flap necrosis and reduced microvessel calibration in the experimental group.

Neural-based flaps are an interesting clinical choice particularly in difficult cases that may not be reconstructed with known techniques. Their popularity is gradually increasing because these flaps offer the advantage of preservation of major extremity arteries and avoidance of microsurgical techniques. Our aim was to explore the feasibility of prefabrication of an osteocutaneous neural island flap model in this study. A peripheral nerve of the rat was implanted into the subcutaneous tissue of a skin flap that was connected to a segment of bone by a soft-tissue bridge, to prefabricate an osteocutaneous flap that was supplied only by the intrinsic vasculature of that nerve after a preliminary delay period. At the end of this study, based on direct observation, microangiographic findings, and additionally, a detailed histologic analysis consisting of both qualitative and quantitative assessments, we have proved that it was possible to prefabricate an osteocutaneous composite flap based on the vascularity of a peripheral nerve after a 2-step delay period. We believe that the clinical application of this new flap will gradually develop based on further experimental studies.

We hypothesized that an osseous tissue can be prefabricated with a peripheral nerve by vascular induction, and by using a rat model, we tested this hypothesis.Twenty Wistar rats were used in the prefabricated neuro-osseous flap study. Bilateral sciatic nerves were placed linearly within the medullary cavities of the femurs. Left femurs were accepted as the experimental group. The right femurs of all the rats were used as internal control where the sciatic nerves were ligated at the bony entrance of the flap.After 6 weeks, all experimental femur flaps were viable. Radioactivity counts and metabolic activity studies showed viable and functional bone tissue in experimental group compared with control group (P = 0.001). On microangiographic evaluation, significant dilatation of the perineural vasculature was observed in experimental group. Histologic investigations showed viable bone tissue only in the experimental group flaps.Due to its easy applicability, reproducibility, and robust circulation, the prefabricated neuro-osseous flap would be an option in reconstructive surgery.