Microsurgical Reconstruction of the Nasal Lining

Abstract

Reconstruction of the nasal lining, alone, is a very challenging endeavor that demands careful surgical planning and precise technical execution. The use of microsurgical transfer for these defects allows considerable latitude for duplication of the missing complex three-dimensional anatomy and avoids sullying the adjacent facial soft tissues. Because of the adverse condition of the local tissues, the majority of these cases could not have been brought to a successful conclusion without the use of free tissue transfer, and this is particularly relevant in the cocaine-injured nose.

Optimal Use of Microvascular Free Flaps, Cartilage Grafts, and a Paramedian Forehead Flap for Aesthetic Reconstruction of the Nose and Adjacent Facial Units

“…The current technique of aesthetic reconstruction with microvascular free flaps developed from our use of several different approaches to nasal lining, 3 two of which produced a less than optimal nasal airway. In the first approach, a large single skin paddle or flap was used for nasal lining.…”

Free Anterolateral Thigh Fascia Lata Flap for Complex Nasal Lining Defects

“…A patent nasal airway often depends on the bulk of the reconstruction, particularly of the ala. Local flaps, including the nasal turn-in flap, nasolabial flap, and forehead turn-in flap (hinged flap), may be used for reconstruction of the nasal lining, but these flaps are also bulky and provide only limited amounts of reconstructive tissue. 1,7 Walton et al 5 and Moore et al 13 have extensively demonstrated the use of free flaps for total nasal reconstruction. The most commonly used flap in these series is the radial forearm free flap.…”

“…4 Repair of large defects has been described using distant skin via free tissue transfer, most commonly the radial forearm free flap. 5,13 The nasal skeleton is manufactured most often from autogenous costal, septal, and auricular cartilages and bone placed during the primary or intermediate reconstruction. Appropriate coverage and inner lining to nest the reconstructed nasal skeleton are essential to provide graft nourishment and survival.…”

“…Although this flap is one of the more pliable and thin flaps used in free tissue transfer, multiple debulking procedures are required until an adequate nasal airway may be achieved. [5][6][7] Overall use of the anterolateral thigh (ALT) free flap for head and neck reconstruction has increased greatly during the past decade, and many surgeons now use this flap preferentially for cutaneous and mucosal replacement. Cutaneous perforators within this flap pass through and vascularize the fascia lata, thus allowing for development of a free vascularized fascia flap.…”

Microsurgical Reconstruction of Maxillary Defects

“…An intermediate stage may be needed to further modify the flap, such as thinning, delaying, or adding additional tissue. [84] At the next stage, when the remote composite flap is completed, it is transferred to the defect based on the original axial blood supply. As with any composite graft, these added layers have to be sufficiently thin or small for them to take.…”