Our algorithm for nasal reconstruction.

Nasal reconstruction is always challenging for plastic surgeons. Its midfacial localisation and the relationship between convexities and concavities of nasal subunits make impossible to hide any sort of deformity without a proper reconstruction. Nasal tissue defects can be caused by tumor removal, trauma or by any other insult to the nasal pyramid, like cocaine abuse, developing an irreversible sequela. Due to the special characteristics of the nasal pyramid surface, the removal of the lesion or the debridement must be performed according to nasal subunits as introduced by Burget. Afterwards, the reconstructive technique or a combination of them must be selected according to the size and the localisation of the defect created, and tissue availability to fulfil the procedure. An anatomical reconstruction must be completed as far as possible, trying to restore the nasal lining, the osteocartilaginous framework and the skin cover. In our department, 35 patients were operated on between 2000 and 2002: three bilobed flaps, five nasolabial flaps, two V-Y advancement flaps from the sidewall, three dorsonasal flaps modified by Ohsumi, 19 paramedian forehead flaps, three cheek advancement flaps, three costocondral grafts, two full-thickness skin grafts and two auricular helix free flaps for alar reconstruction. All flaps but one free flap survived with no postoperative complications. After 12-24 months of follow-up, all reconstructions remained stable from cosmetic and functional point of view. Our aim is to present our choice for nasal reconstruction according to the size and localization of the defect, and donor tissue availability.     

Prefabricated Nasolabial Flap for Reconstruction of Full-Thickness Distal Nasal Defects

BACKGROUND: The reconstruction of full-thickness nasal tip and alar defects is challenging owing to the distal nose's triple-layer structure: skin, cartilage, and mucosa. OBJECTIVE: In the reconstruction of wounds of the distal half of the nose involving the rim, the most important issue to be considered is to provide a good functional and an acceptable esthetic result. Various local and distant flaps have been described for this purpose. The nasolabial flap is one of the most frequently used flaps in reconstruction of small- to moderate-size distal nasal defects. Its reliable blood supply, minimal donor site morbidity, and excellent texture and color match are some of the advantages of this local flap. METHODS: In this study, superiorly based subcutaneous pedicled nasolabial flaps have been prefabricated with cartilage and skin grafts. This method has been used in 10 cases. RESULTS: One patient had partial flap necrosis, and two patients experienced hyperpigmentation on the suture line. Scar revision was performed in one patient for hypertrophic scar tissue at the flap margins. No other complications were seen in the remaining patients. None of the patients experienced a skin graft loss or cartilage exposure. CONCLUSION: The prefabricated nasolabial flap offers a superior esthetic and functional result and may be an appropriate reconstructive option in reconstruction of small- to moderate-size distal nasal defects.     

四种局部穿支皮瓣在鼻翼缺损修复中的应用

目的探讨4种局部穿支皮瓣修复鼻翼缺损的应用方法及临床效果。方法回顾性分析2015年6月至2018年6月安徽医科大学第一附属医院收治的41例各种原因导致的鼻翼缺损患者的临床资料,其中男22例,女19例,年龄15~93岁,平均45岁。鼻翼处缺损处面积为0.4 cm×0.4 cm^2.5 cm×2.5 cm,分别采用鼻唇沟角形穿支皮瓣(20例)、鼻翼基底穿支鼻唇沟岛状皮瓣(6例)、唇上-鼻唇沟角形穿支岛状皮瓣(5例)或鼻外侧动脉角形穿支皮瓣(10例)进行修复。术后对患者进行随访,观察鼻翼形态和鼻部功能,以及癌肿病例复发情况。结果41例皮瓣全部成活,皮瓣切取范围为0.5 cm×1.5 cm^4.0 cm×4.0 cm,鼻翼缺损完全修复,伤口均为一期愈合。术后所有病例均进行了4个月至1年的随访,术后鼻翼形态较好,鼻部功能未受影响,癌肿病例未见复发。结论鼻翼缺损面积较大时选用鼻唇沟角形穿支皮瓣,面部皮肤张力较大时采用鼻翼基底穿支鼻唇沟岛状皮瓣经皮下隧道修复,缺损邻近鼻唇沟处时宜用唇上-鼻唇沟角形穿支皮瓣,缺损面积较小时采用鼻外侧动脉角形穿支皮瓣修复。根据情况合理地选择皮瓣,均可获得较好的美学效果。     

Nasalis Flap and Graft Repair Provides Reliable Closure for Denuded Defects of the Nose

BACKGROUND: Skin cancer surgery involving the nasal tip and dorsum sometimes results in exposure of underlying bone or cartilage. We describe a simple method of providing a vascular bed for the defect using the superficial nasalis musculoaponeurotic system (SNAS) of the nose, which allows full-thickness skin graft reconstruction of the defect and an acceptable cosmetic outcome. OBJECTIVE: The utility of nasalis flaps to provide a vascular bed for grafting has not been specifically addressed in the dermatology literature. Our experience with 26 SNAS flaps is outlined to demonstrate the utility of this closure in the appropriate situations. METHODS: A discussion of the relevant anatomy is followed by an outline of the surgical technique. Results: SNAS flaps provide a reliable vascular bed and contour for defects of the bridge and distal nose. Complications have been few. CONCLUSIONS: The SNAS flap and graft are simple to perform and provide a reliable alternative to interpolated nasolabial or forehead flaps when the defect exposes significant bare cartilage or bone.     

鼻唇沟皮下蒂岛状皮瓣修复鼻部皮肤缺损

目的：探讨鼻唇沟皮下蒂岛状皮瓣在修复鼻部皮肤缺损中的应用。方法：应用鼻唇沟皮下蒂岛状皮瓣对12例患者修复鼻部皮肤缺损,缺损部位包括鼻翼、鼻尖及鼻背,最大缺损面积3．0cm×4．0cm。皮瓣沿鼻唇沟走行方向设计,蒂宽1．0～1．5cm,皮瓣长宽比不超过3：1,蒂部旋转点位于皮瓣远端与缺损远端连线的中点。结果：12例患者皮瓣全部成活,其中1例因蒂部卡压术后当天皮瓣颜色略紫,术后第2天予蒂部松解后好转。术后随访半年到1年,皮肤质地、色泽与周围皮肤相近,瘢痕不明显。结论：鼻唇沟皮下蒂岛状皮瓣是修复鼻部皮肤缺损的理想方法。     

烧伤后鼻部及邻位组织缺损畸形的修复

目的 了解烧伤后鼻及邻位组织缺损的最佳修复方法 及效果. 方法 1999年1月-2008年12月,笔者单位采用额部扩张皮瓣、上臂带蒂皮瓣、耳后反流轴型岛状皮瓣及鼻唇沟皮瓣,修复烧伤后鼻部及邻位组织缺损畸形患者12例,其中全鼻缺损4例,鼻部分缺损8例.12例患者巾鼻缺损伴面颊部瘢痕3例,伴额部瘢痕5例,伴上唇外翻及上唇大部分缺损共5例.皮瓣面积3.0cm × 1.5 cm～10.0 cm×8.0 cm. 结果 采用额部扩张皮瓣修复5例、上臂带带皮瓣修复3例、耳后反流轴型岛状皮瓣修复1例、鼻唇沟皮瓣修复3例.12例皮瓣全部成活.随访1～7年,患者鼻的功能及外形均明显改善. 结论 额部皮瓣为修复烧伤后鼻缺损的首选皮瓣.面部严重烧伤,瘢痕明显,不能选择局部皮瓣或邻位皮瓣时,可考虑应用上臂带蒂皮瓣、耳后反流轴型岛状皮瓣等修复.     

Reconstruction of the nasal alar defect with the superiorly based nasolabial flap described by Burget: report of seven cases

Background

The reconstitution of a nasal alar rim and lobule defect represent a difficult challenge in consideration of his situation, anatomy and function. This article describes the technique and the interest of the nasolabial flap when used to cover the entire alar subunit.

Methods

We present 7 cases of alar rim and lobule defect after skin cancer excision. In the series, there are two full-thickness with lining defect. The patients were reconstructed with a superiorly based nasolabial flap, according to the subunit principle as introduced by Burget. A free cartilage graft was used to restore structural support with marginal skin flaps were turned over for intranasal lining when necessary.

Results

The cosmetic and functional outcomes of each repair were judged from good to excellent by patients and surgeons. No case of flap infection or necrosis occurred.

Conclusion

The superiorly based nasolabial flap, describe by Burget, provides an excellent choice for cosmetic and functional reconstruction of the nasal alar defect.     

下蒂鼻唇沟皮瓣在鼻翼缺损修复中的应用

目的：探讨下蒂鼻唇沟皮瓣修复鼻翼缺损的治疗效果。方法：用鼻唇沟下蒂皮瓣旋转做成鼻翼外侧面,使用口腔粘膜缝合于皮瓣背侧面做衬里,对鼻翼缺损15例进行手术修复。结果：15例均病例皮瓣存活,鼻翼外形满意,瘢痕不明显。结论：利用逆行鼻唇沟带蒂皮瓣修复鼻翼缺损方法简单,效果满意,值得推广。     

局部皮瓣在鼻部皮肤恶性肿瘤切除后创面修复中的临床应用

目的:探讨应用局部皮瓣在鼻部皮肤恶性肿瘤切除后修复创面缺损的方法和效果。方法:2012年1月到2014年1月收治的鼻部皮肤恶性肿瘤患者39例。其中基底细胞癌31例,鳞状细胞癌8例,所有患者病变局限且未发现转移证据。手术切除肿瘤后根据缺损的大小、形状、位置及周围皮肤情况设计局部皮瓣进行修复。皮瓣大小为0.8cm×1.0cm~4.5cm×5.0cm,其中菱形皮瓣9例,双叶瓣1例,V-Y皮瓣4例,O-Z皮瓣5例,鼻唇沟皮瓣15例,额鼻皮瓣4例,额瓣1例。结果:37例患者缺损区局部皮瓣修复后Ⅰ期愈合,2例患者切口感染,经抗炎治疗并加强换药后Ⅱ期愈合。供区均未形成继发性缺损,达到Ⅰ期愈合。全部患者术后随访8~20个月,恶性肿瘤均无复发。鼻部外形总体轮廓良好,移植皮瓣与周围皮肤在颜色、质地等方面匹配良好,达到满意的面部形态和整形美容效果。结论:鼻部恶性肿瘤切除后根据缺损创面的大小、位置、形状及周围皮肤情况选用合适的局部皮瓣进行修复,可以取得较好及稳定的整形美容效果。     

Expanded Median Forehead Flap and Abbé Flap for Nasal and Upper Lip Reconstruction After Complications of Polymethylmethacrylate

Despite the benefits from the minimally invasive technique, complications may occur, raising doubts about the safety of polymethylmethacrylate as an injectable filler material. The authors report their treatment of a patient from another institution with necrosis involving full-thickness nasal skin and upper lip after injection of polymethylmethacrylate in the nasolabial folds and nose for augmentation. An expanded median forehead flap was used to reconstruct the nose, and an Abbé flap was used for the upper lip. The flaps and the skin expander allowed reconstruction with correct texture, color, and dimensions, producing a good aesthetic and functional outcome.     

鼻再造术中衬里组织的修复方法

目的探讨鼻再造术中衬里组织的修复方法。方法根据局部组织条件,应用局部翻转皮瓣、口腔黏膜瓣、鼻唇沟皮瓣和预构皮瓣等方法,对24例鼻缺损患者的鼻衬里进行了修复,并转移额部皮瓣和移植自体肋软骨行鼻再造术。术后通过6-34个月的随访,以了解鼻腔衬里组织的情况,如挛缩、破溃等,评价各方法的疗效。结果本组17例采用局部翻转皮肤、瘢痕作为鼻腔衬里,1例采用口腔黏膜瓣,5例采用局部皮瓣,1例采用预构皮瓣重建衬里。再造鼻额部皮瓣及衬里皮瓣均存活,外形逼真,仅瘢痕瓣通气不良。结论在鼻再造术中,正确评估鼻部缺损范围、程度及鼻周残留组织量,选择适当的衬里修复手术方案,可收到良好的手术效果。预构皮瓣可以很好地修复复杂鼻缺损的衬里。     

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

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.     

局部或邻位皮瓣在鼻尖缺损修复中的功能和美学评价

目的 介绍应用局部或邻位皮瓣修复鼻尖部缺损创面的方法和经验.方法 在遵循鼻亚单位组成的美学原则基础上,根据鼻尖部创面的大小、形状及供区组织可利用情况,分别选择相应的局部或邻位皮瓣(如额鼻皮瓣、双叶皮瓣、改良菱形皮瓣、鼻唇沟皮瓣及额正中皮瓣等)修复创面,供区直接缝合.结果 手术治疗共83例,创面面积最小约0.6 cm×0.6 cm,最大约2.5 cm×2.5 cm.术后皮瓣全部成活,无明显并发症发生.其中76例随访1～36个月,鼻外形轮廓较好,修复组织与周围皮肤相匹配,肿瘤患者未见复发.结论 遵循鼻亚单位美学原则,应用局部皮瓣能修复鼻尖部中等以上创面,且色泽、质地、轮廓等方面能达到较好的匹配和协调.     

Nasolabial V-Y Advancement for Closure of the Midface Defects

BACKGROUND: V-Y subcutaneous advancement flaps receive an excellent blood supply from subcutaneous tissue and are ideal for use on the face. Also it is advantageous cosmetically compared to other local flaps. OBJECTIVE: Nasolabial V-Y advancement flaps are very useful in closing defects of the midface region after tumor resection. METHODS: Our experience with nasolabial V-Y flaps in 22 patients is reported. The average defect size was 2.4 cm x 3.2 cm. RESULTS: Minor flap necrosis occurred in one patient and simple lower eyelid ectropion in another. CONCLUSION: Nasolabial V-Y advancement flap is a simple and satisfactory alternative for closing relatively large defects in the midface when compared with other methods such as skin graft and rotation or transposition flaps. It is easy to design, reliable, and offers good cosmetic results.     

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.     

Use of bilateral retroangular flaps for reconstruction of the glabella and nose.

We report the use of bilateral retroangular flaps for reconstruction of the glabella and nasal tip following extirpation of a cavernous haemangioma. The vascularity of the flaps was good, and the colour and texture match excellent. Donor-site closure was easy, and the scar in the nasolabial groove was not conspicuous. Our experience demonstrates that this flap is useful for reconstruction of skin defects of not only the nose but also the glabella and forehead. By raising bilateral flaps, a wide skin defect in the centre of the face can be repaired.     

Reverse-Flow Retroauricular Island Flap in Facial Reconstruction

BACKGROUND Reconstruction of facial skin defects requires good-quality skin cover to satisfy aesthetic expectations of patient, especially when the skin defect is on the uncovered area of the face. Limitations in the available local tissue and donor-site morbidity restrict the options.
OBJECTIVE In an effort to solve these problems, we have begun to use a subcutaneous pedicled retroauricular reverse-flow flap.
METHODS Between January 1997 and December 2005, reverse-flow subcutaneous pedicled retroauricular island flap was used to cover facial defects in 12 patients who underwent surgical excision of skin tumor. The patients ranged in age from 44 to 81 years with a mean age of 58 years.
RESULTS Only one case experienced a superficial necrosis in the distal one-quarter part of the flap. The functional and aesthetic results were satisfactory for both patients and surgeons, and no tumor recurrence was observed during the 12 to 28 months (mean, 18.8 months) follow-up period.
CONCLUSIONS This flap can be used reliably for the reconstruction of facial skin defects of small and medium size. The preference of frontal branch pedicled flap enables more distal facial area defects to be covered, such as dorsal nasal, nasolabial, and upper lip, than flaps based on parietal branch.     

One-stage reconstruction of nasal skin defects with local flaps

Summary Post-excision reconstruction of nasal skin defects may often be accomplished with local sliding flaps, which provide good skin, with perfect color match, in one operation.The rectangular sliding flap gives excellent results when used to reconstruct limited defects of the dorsum of the nose, from the root to the tip.Island flaps sliding on their own subcutaneous tissue deserve consideration in many cases. Taken from the frontoglabellar and nasolabial regions, where the skin is very mobile in old patients, they may be combined to cover even extensive defects.     

Use of nasolabial flap in facial plasty

Using nasolabial flaps, 32 facial plastic operations were carried out and satisfactory results were obtained in all 32 cases. There were ectropion of the upper lip in 16 cases, ectropion of the lower lid in 14 cases and inferior nasal defect in 2 cases. This nasolabial flap can be transferred directly or through subcutaneous tunnel to repair a minor defect of the lower lid, the upper lip or nose etc. It give the best color and texture match. The ratio of length to width of the flaps was 4 to 1 or lower. The donor site within 3 cm can be directly suture and its scar along the nasolabial crease is vague. The operation is simple and aesthetic result is good.     

Paranasal transposition flap in facial soft tissue reconstruction of facial cleft Tessier type 3 & ADAM complex: A case report

IntroductionCraniofacial Tessier Cleft type 3 as a common craniofacial cleft with nasolabial region soft tissue defect, forced surgeons to find their ways of reconstructing using localregional flaps to provide defect closure. The cleft may occur in existence with other constriction band syndrome entity such as the ADAM complex. The effort to repair and give back the basic function for daily activity, put surgeons to find ways and one among them are soft tissue reconstruction using most reliable are forehead and melolabial flaps. However, many cases may limit their usages.Case presentationA four-month-old boy presented with ADAM complex syndrome with bilateral facial cleft Tessier 3 was done soft tissue reconstruction to repair the bilateral cleft lips using a combination of the paranasal flap. No early treatment approach such as molding was used. Although the cleft was wide enough, with limitation in flap modality, the wound healing was remarkable with no dehiscence.Clinical discussionThis patient nasal/glabellar flap was not feasible due to glabellar region defect. Some functional and aesthetic limitations of those flaps highlight situations in which the inferior-based interpolated paranasal flap (IPNF) offers an advantageous alternative.ConclusionThus, an alternative flap from inferiorly based paranasal flap proven to be good flap modalities for alar nasal area. This case report shows the good result of design, lacks, and benefit in using paranasal flap.