Three-Dimensional Nasal Reconstruction Using a Prefabricated Forehead Flap: Case Report

Abstract

Surgical treatment is extremely difficult with the combined defects of skin, cartilage, and nasal mucosa. Besides efforts geared toward ascertaining the best aesthetic outcome, an important concern is restoring normal nasal function. This can be achieved only by providing sufficiently and anatomically adapted cartilage and bone support, followed by covering the inner part using tissue closely resembling mucosa and the outer part using skin compatible with the surrounding skin. The surgical technique for three-dimensional nasal reconstruction in the first session of this study involved placing a silicon sheet between the skin and galea, which allowed two separate flaps to be obtained for the next session without vascular damage. For the epithelialization of the defect on the nasal surface, the lower surface of the galea was prefabricated with a thin skin graft obtained from the thigh. In this way, nasal mucosa cover was ensured. The expander placed under all these structures thinned them down to a thickness close to that of nasal skin and mucosa and also enabled primary closure of the donor area. Thus, the defect that emerged during the second session in cartilage framework was repaired by cartilage grafts taken from the nasal septum. The mucosal surface and skin part then could be closed with two separate flaps. The forehead flap used in this technique enabled production of an aesthetically and functionally satisfactory outcome by providing an anatomically sufficient amount of nasal skin and nasal mucosa for whole-layer wide nasal defects in only three sessions without necessitating an additional flap.

Key issues in nasal reconstruction

“…Alagoz et al [29] reported combining the earlier technique with tissue expansion for very large nasal, septal, and columellar defects. A silicone sheet is implanted between the galea and subcutaneous tissue at the same time as a tissue expander is placed deep to the galea.…”

Reconstruction of the columella and the tip of the nose with an island-shaped forehead flap

“…Island-shaped front flap is usually used in reconstruction of partial defects in the upper two-thirds of the nose or for total nose reconstruction 3,5,6,13,14,[22][23][24][25][26][27] .…”

“…Island-shaped arterial frontal lobe of supratrochlear blood vessels was used for reconstruction of larger nose defects or partial defects in the upper and middle part of the nose 3,5,6,13,14,[22][23][24][25][26][27][30][31][32] . Island-shaped arterial frontal lobe of supratrochlear blood vessels was used for reconstruction of larger nose defects or partial defects in the upper and middle part of the nose 3,5,6,13,14,[22][23][24][25][26][27][30][31][32] .…”

Flap prefabrication using high-density porous polyethylene in an animal model – an experimental study

“…These flaps are mainly used in head and neck reconstruction to achieve similar texture, shape, and color to those of recipient site; however, prefabrication is usually reserved for individual cases in which conventional techniques are unreliable or unavailable. Prefabrication is the process of making flaps to fulfill specific requirements by designing them with only required components in new vascular areas while minimizing donor site morbidity [1,2]. Instead of secondary corrections for a standard flap, the prefabricated complex is finished before the final free flaps stage is entered.…”