Osteocutaneous radial forearm free flap in subtotal nasal reconstruction

Abstract

SUMMARYA 66-year-old man presented with a large squamous cell carcinoma of the right nasal vestibule. He underwent partial rhinectomy and medial maxillectomy followed by staged reconstruction. Reconstruction of a full-thickness nasal defect requires repair of three distinct layers: the skin-soft tissue envelope, subsurface framework and intranasal lining. We report the first use in the UK of an osteocutaneous radial forearm free flap in the reconstruction of a subtotal nasal deficit. The skin of the radial forearm free flap was tubed to recreate the nasal lining and the radial bone reconstructed the dorsal contour of the nose. A full-thickness paramedian forehead flap supplied external coverage. The osteocutaneous radial forearm free flap and forehead flap is a viable option for large nasal defects requiring reconstruction of framework, nasal lining and external covering. BACKGROUND

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

“…The primary search identified 305 unique articles, of which 257 were excluded after title and abstract review (Figure ). After 48 full‐text articles were reviewed by two independent reviewers (MR and GK), a total of 22 articles fulfilled the inclusion criteria (Acikel, Bayram, Eren, & Celikoz, ; Beahm, Walton, & Burget, ; Burget & Walton, ; Choi, Joo, Jeong, & Jang, ; Cinpolat, Bektas, & Coskunfirat, ; Fujioka, Hayashida, Murakami, & Koga, ; Gaggl, Burger, & Chiari, ; Hirase, Kojima, Takeishi, Hayashi, & Shinoda, ; Hsiao et al, ; Karadsheh, Turfe, & Komorowska‐Timek, ; Livaoglu, Karacal, Bektas, & Bahadir, ; Menick & Salibian, ; Moore, Montgomery, McMahon, & Sheikh, ; Moore, Strome, Kasperbauer, Sherris, & Manning, ; Nisanci, Turegun, Er, & Sengezer, ; Senda et al, ; Seth, Revenaugh, Scharpf, Shipchandler, & Fritz, ; Swartz, ; Upton, Ferraro, Healy, Khouri, & Merrell, ; Wehrens, Hawinkels, Fresow, Van der Hulst, & Boeckx, ; Winslow, Cook, Burke, & Wax, ; Zhou, He, Liao, & Yao, ). Study design consisted of 13 case reports and 9 case series (Table ).…”

Clinical study regarding nasal reconstruction methods

“…The free flaps are the reconstruction method used for total nasal defects, but this technique is very difficult and has many complications 9 .…”

A Unique Method for Total Nasal Defect Reconstruction - Prefabricated Innervated Osteocutaneous Radial Forearm Free Flap

“…For inner lining – which is the most difficult to reconstruct - a variety of different free flaps have been described [6, 7]; among them, radial forearm flap is most widely used, yielding a reliable end result [3, 8, 11, 12]. Reconstruction using osteocutaneous radial forearm free flap, has been previously proposed by some authors [4, 9, 10, 13]. We believe it is a good reconstructive option and should be proposed to the patient with total nasal defect.…”

“…Nose inner lining remains the most difficult to reconstruct, with most of the reconstructive surgeons favouring microvascular free flap transfer [3–8]. For total nasal defects, reconstruction with osteocutaneous radial free flap alone or with combination with other local flaps, have been proposed [4, 9, 10].…”