Microvascular lining options for subtotal and total nasal reconstruction: A scoping review

Abstract

Background: Restoration of nasal lining is essential in reconstruction of subtotal/total nasal defects. When local flaps are inadequate, a microvascular flap should be used. The purpose of this scoping review is to map the literature and identify the described flap options for subtotal/total nasal reconstruction. Further to that, we will summarize the stated advantages and disadvantages, evaluate functional and esthetic outcomes, and appraise the current body of literature. Methods: An electronic literature search was completed. Studies required adult patients with subtotal/total nasal defects and lining reconstruction with microvascular free flap. Two independent reviewers completed screening and data extraction. Flap characteristics, advantages, disadvantages, functional and esthetic outcomes were reviewed. Two independent reviewers evaluated study quality. Results: Of 305 initial articles, 22 studies were included (13 case reports, 9 case series) accounting for 65 flaps. Microvascular flaps varied by composition and anatomical location. For functional outcome, 13 studies used clinical exam by surgeon, 5 reported patient being satisfied, 3 studies used endoscopy, and 1 study used nasometry. Assessing esthetic outcome, 13 studies used clinical exam by surgeon, 5 studies reported patient being satisfied, 1 study used patientreported outcome measures, and 16 studies included photos. Study quality (modified CARE and PROCESS checklists) was deemed poor. Quality of available evidence was level IV.Conclusions: Microvascular free flaps for nasal reconstruction, confer an overall satisfactory functional and esthetic outcome. All studies lack a systematic and comprehensive approach to assessing and reporting these outcomes. Future research should provide objective assessment and utilize patient reported outcome measures.

Microsurgical Reconstruction of the Nose: The Aesthetic Approach to Total Defects

“…The ALT flap is the second most frequently used free flap for lining reconstruction, described in the 17% of the cases. 12 In our case series, lining reconstructions using ALT flap was comparable to RFF flap in term of number of treated patients, feasibility, surgical stages, functional and aesthetic outcomes, and complications.…”

“…3 Ramji et al in a recent review found only few reports of microvascular lining reconstruction described in literature, with a total of 65 cases. 12 Afterward, Salibian et al published their 17-year experience in microvascular reconstruction of the nose with 47 patients. 8 In this article, we present our 19year experience in 21 consecutive patients, with full-thickness total/subtotal or heminasal defects, who underwent complex nasal reconstruction with microsurgical procedure.…”

“…Rami et al found that the RFF was the first choice in the 51% of microvascular lining reconstruction. 12 The forearm, indeed, is a thin and well vascularized flap, with a long and safe vascular pedicle, despite the considerable donor site morbidity. The ALT flap is the second most frequently used free flap for lining reconstruction, described in the 17% of the cases.…”

Custom designed radial forearm free flap for reconstruction of nasomaxillary defects: Report of two cases

“…The RFFF is the most common microvascular flap reported for nasal reconstruction (Menick & Salibian, 2011; Ramji et al, 2019; Marshall et al, 2003; Fujioka et al, 2012). Literature describes the use of other microvascular free flaps as a reliable option for lining reconstruction of total nasal defects (Ramji et al, 2019). Type of nasal defect and patient characteristics should be considered when choosing the reconstruction technique.…”

“…Reconstruction implies reproducing the nasal aesthetic subunits (Burget & Menick, 1985, 1989) and the three nasal components: internal lining, osteochondral structure and external skin (Menick & Salibian, 2014; Menick, 2016). Different techniques have been described to treat total nasal defects (Brown & Shaw, 2010; Menick, 2010; Menick & Salibian, 2011; Brunetti et al, 2019; Ramji et al, 2019). This article reports a new custom design of the radial forearm free flap (RFFF) treating total nasal defects where the tip of the nose was preserved.…”