Double Forehead Expanded Flaps for Reconstruction of Total Nasal Defect: A Case Report

ObjectiveTo introduce a method for total nasal defect reconstruction with a double forehead expanded flap.Case presentationA 55-year-old man underwent three-stage total nasal reconstruction for a complete nasal defect due to electrical injury. The skin expander was implanted during the 1st stage. Total nasal reconstruction was performed with double expanded forehead flap transfer during the 2nd stage. The unilateral forehead flap was used for lining and the contralateral forehead flap, together with the autologous cartilage and titanium mesh framework, were used for skin replacement. The forehead donor defect was covered with a skin graft. Pedicle division and inset were performed in the 3rd stage.ResultsThere was no flap loss, infection, hematoma, rhinostenosis, or implant exposure over the 2-year follow-up, and satisfactory aesthetic results were achieved.ConclusionThe double forehead expanded flap method is useful for the reconstruction of large composite nasal defects in patients who are not suitable for nasolabial flaps and those who may not tolerate free tissue transfer. The operation has fewer complications and is uncomplicated.     

Patient Wellbeing and Quality of Life After Nasoseptal Flap Closure for Endoscopic Skull Base Reconstruction

BackgroundThe endoscopic endonasal approach to the skull base avoids some of the surgical morbidity associated with a transcranial approach, however it often results in large skull-base defects requiring secure closure. The nasoseptal flap has become the preferred method for closure of such defects but may be associated with its own morbidity.MethodsA consecutive cohort of patients with skull base pathology with prospectively collected quality of life data using ASBQ and SNOT was analysed. They were grouped into those who received a nasoseptal flap and those who did not. Pre-operative total ASBQ and SNOT scores, and their individual components, were compared to data collected at days 1, 3, and 7; six-weeks; and 3, 6, and 12-months postoperatively.ResultsOf 158 patients available for analysis, nasoseptal flaps were performed in 52 (33%). Average follow-up (±standard deviation) was 8.1 ± 3.9 months for ASBQ data and 8.2 ± 3.8 months for SNOT data. In the first post-operative week, nasal symptoms and otalgia were worse in the flap group. At six-weeks and beyond, there was no difference between groups in overall ASBQ or SNOT scores, or in the rate of clinically-significant improvement in SNOT or ASBQ scores or their components.ConclusionIn the largest cohort of patients to date, the use of a nasoseptal flap is associated with nasal symptoms and otalgia in the acute post-operative period, but is not associated with any long-term detriment to quality of life after endoscopic skull base surgery.