No abstract

Skin grafts offer a dynamic repair option for nasal defects of appropriate size, depth, and location. Granulation and grafting can successfully be used as stand-alone reconstructive options or in conjunction with flap repair. This article reviews suitable indications for graft and granulation use in nasal repair to achieve optimum functional and esthetic outcomes.

Nasal reconstruction has been articulated in the literature since 700 B.C. when the earliest iteration of the forehead flap was described in the Indian medical treatise, the Sushruta Samhita. Since then it has evolved into the interpolated flap which has served as a powerful tool for facial reconstruction. The interpolated flap is constructed from nonadjacent donor tissue that has an inherent blood supply. It requires a multistaged approach and is best suited for reconstruction of large or deep defects of the nose. There are three types of interpolated flaps used for nasal reconstruction: the forehead, melolabial, and nasofacial interpolation flaps. The nose is the central feature of the human face and its placement is both aesthetic and functional. Any defects owing to accidental or iatrogenic trauma can cause physiologic and psychological injury to patients. This article aims to review the aforementioned flaps and give indications, contraindications, procedure details, and future directions of these flaps.

BACKGROUND The bilobed transposition flap recruits the relatively thinner and laxer skin of the nasal dorsum and sidewall to reconstruct defects of the more sebaceous nasal tip and alae. There have been no studies performed to quantify how the material properties of skin alter the bilobed flap's performance during nasal reconstruction. OBJECTIVE To determine the effects of skin thickness and stiffness on bilobed flap mechanics to help guide flap design principles and optimize surgical outcomes. MATERIALS AND METHODS Two-dimensional artificial silicone skin models of varying thickness were created. The bilobed flap was incised, transposed, and secured in standard fashion. Digital image correlation was used to translate model deformation and displacement into local stress and mechanical strain forces within the bilobed flap pedicle. RESULTS Qualitatively, the center of rotation of the bilobed flap rotates superiorly up the flap pedicle as model skin thickness increased. CONCLUSION Location of the bilobed flap's pivot point may be dependent on local tissue characteristics—oversizing of the primary lobe can be considered in stiff, immobile tissue such as highly sebaceous Zone II nasal skin.