Paramedian Forehead Flap Reconstruction for Nasal Defects

Background. The paramedian forehead flap is the ultimate reconstructive method for repair of extensive nasal defects. Changes in technique have resulted in the evolution of the modern-day forehead flap, which is a streamlined, efficient, reliable flap that can be counted on to provide superior function and cosmesis in the reconstruction of large nasal defects.
Objective. Consistent success in the execution of a forehead flap hinges on a careful stepwise approach to the defect, the patient, and the surgical technique. Characterization of these steps was undertaken to assist the surgeon in achieving consistent post- operative results.
Methods. The process of executing a paramedian forehead flap beginning with preoperative assessment through the intraoperative procedure and culminating in the postoperative care is elucidated and discussed.
Results. Through thoughtful planning and correct execution of technique, very large nasal defects are reconstructed, with excellent functional and esthetic results. Specific examples illustrate the range of approaches that can be used to address a variety of nasal tissue loss.
Conclusion. With careful attention to the reconstruction of all components of a nasal defect, a forehead flap can restore virtually any large nasal defect with excellent functional and cosmetic results. The skill sets that help optimize the process of nasal reconstruction are important to acquire. With careful planning and surgical finesse, forehead flaps can often result in nearly imperceptible restoration of the nose.     

Superiorly Based Nasolabial Interpolation Flap for Repair of Complex Nasal Tip Defects

BACKGROUND: Reconstruction of full-thickness defects of the nasal tip is one of the most challenging aspects of cutaneous oncologic surgery. It is imperative that the cutaneous surgeon be intimately familiar with all the available surgical options to provide for the best postoperative outcome. OBJECTIVE: To describe an additional surgical option for reconstruction of complex small to medium-size full-thickness nasal tip defects involving more than one cosmetic unit. METHODS: Three patients underwent reconstruction of complex full-thickness nasal tip defects using a two-stage nasolabial interpolation flap. RESULTS: Closure of each surgical defect was achieved with the two-stage nasolabial interpolation flap with good cosmetic results in the first postoperative year. CONCLUSIONS: The two-stage nasolabial interpolation flap is a useful tool in the reconstruction of complex full-thickness defects of the nasal tip.     

Evaluation of the Median Forehead Flap and the Nasolabial Flap in Nasal Reconstruction

Basal cell carcinoma, which accounts for 70%–80% of all cutaneous malignancies in the United States, has increased recently in Japan. We compared methods for reconstruction after surgery for basal cell carcinoma, which is expected to increase further in the future. Thus patients who underwent reconstruction after surgery for basal cell carcinoma of the nose using medial forehead flaps and nasolabial flaps were selected, and the effectiveness of these flaps was compared by taking the size and location of the tissue defect into consideration. As a result, possibly because of anatomical and histological differences of the face between Caucasians and Asians, better results were obtained with nasolabial flaps than with median forehead flaps.     

The Bilobed Flap for Reconstruction of Distal Nasal Defect in Asians

Background  The aim of this study was to overcome nasal alar retraction that occurs with the use of the standard Zitelli’s bilobed flap for reconstruction of a distal nasal defect. Zitelli’s bilobed flap offers the ability to aesthetically reconstruct difficult defects in the distal nasal area. However, the standard Zitelli bilobed flap may sometimes result in nasal alar retraction which is likely to the result of excessive tension upon closure of the primary lobe and primary defect. Methods  We modified the bilobed flap based on the design of the standard Zitelli bilobed flap. The modification of the bilobed flap was designed to have a primary lobe that was 10% longer than the length of the distal defect edge from the flap’s pivot point, and the width of the primary lobe was equal to the width of the defect. The length of the secondary lobe was 130% of the length of the distal defect edge to the flap’s pivot point, and the width of the secondary lobe was two-thirds the width of the primary lobe. To make a slight downward displacement of the ipsilateral alar margin, the primary lobe was transposed to fill the primary defects. Results  The results of the reconstruction were satisfactory: there was good nasal contour and appropriate symmetry of the nasal tip and no alar retraction. Conclusion  The modification of Zitelli’s bilobed flap to have a longer primary lobe, which slightly displaced downward the ipsilateral alar margin intraoperatively, can prevent nasal alar retraction in the reconstruction of distal nasal defects in Asians.     

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.     

Trilobed Skin Flap on the Face: For Reconstruction of Full-Thickness or Commissural Defects

BACKGROUND: Although many local skin flaps have been described for reconstruction of defects on the face, there are still some difficulties in reconstruction of full-thickness defects of alar and ear region and commissural defects in periorbital and perioral region. OBJECTIVE: A trilobed skin flap can offer single-stage reconstruction of difficult full-thickness or commissural defects. We performed trilobed skin flaps in reconstruction of the defects on the face. The design of the flap and outcomes of the procedures are presented. METHODS: Twelve patients with skin cancer on the face were operated under general or local anesthesia. After tumor resection, defects were closed with a trilobed skin flap. Patients were followed-up for a minimum 6 months. RESULTS: There was no early or late complication in all patients. Oral competence was achieved in reconstruction of the oral commissure. A new lateral canthus with angles as in the original one was created. Alar and ear reconstructions were performed at one session using the same flap without a graft. The outcome was satisfactory. CONCLUSION: Because it is easy to obtain a trilobed skin flap, it can be used for reconstruction of canthal, oral, and commissural defects, and the new canthus, mouth, and commissures with angles as in the original ones can be created. In addition, the flap can be used for reconstruction of full-thickness defects in the alar region and the ear.     

鼻唇沟皮瓣修复鼻尖及鼻翼缺损的效果

目的 探讨在鼻尖及鼻翼缺损治疗中应用鼻唇沟皮瓣修复的效果。方法 选取2018年6月-2022年 6月我院收治的82例鼻尖及鼻翼缺损患者作为研究对象,均采用鼻唇沟皮瓣修复术治疗,观察并发症发生 情况及治疗满意度,并对患者治疗前后的生活质量进行比较。结果 82例患者皮瓣成活状况均良好,未出 现静脉回流障碍、皮瓣血供障碍等并发症,治疗满意度为96.34%;治疗后躯体功能、躯体角色、活力、社 会功能、情绪角色、心理健康、总健康评分均高于治疗前,差异有统计学意义（P ＜0.05）。结论 鼻唇沟 皮瓣修复鼻尖及鼻翼缺损的效果良好,可有效改善患者的生活质量,且术后并发症发生几率较小,患者满 意度较高。但由于个体差异不同,手术治疗时还需根据患者自身情况制定科学的、合理的治疗方案。     

Immediate Reconstruction of Full-Thickness Chest Wall Defects

Twenty-one patients had full-thickness chest wall defects reconstructed at the New York University Medical Center in the last ten years. Marlex mesh provided chest wall stability in 5 patients. In 9 patients with radiation ulcers Marlex mesh was not required; a severe fibrotic reaction had obliterated the pleural space and prevented paradoxical motion. Partial sternal resections did not require Marlex stabilization, while a total sternectomy resulted in marked ventilatory insufficiency in a patient who would have benefited from the use of a stabilizing material. Random pattern flaps were used initially; more recently, axial pattern, myocutaneous, and myocutaneous free flaps were employed. Necrosis developed in 4 (36%) of the 11 patients with random pattern flaps, but was not seen with the newer flap techniques. Myocutaneous free flaps provided uncomplicated coverage of and stability to three large, potentially contaminated defects. It seems that with the currently available flap techniques and the methods of chest wall stabilization, immediate repair of all full-thickness chest wall defects is possible.     

Crescentic Nasojugal Flap for Nasal Tip Reconstruction

BACKGROUND: Carcinomas of the tip of the nose are very common, and the nasal tip defect is one of the most challenging subunit to reconstruct. There are numerous available procedures for the reconstruction of the tip of the nose. We have developed a flap for the management of a tissue loss from the tip of the nose and report the use of this flap for 11 patients. OBJECTIVE: The purpose of this presentation is to report a refinement of a nasojugal flap for the reconstruction of a nasal tip defect. The flap we describe has the characteristic of excising the dog-ear, created by the movement of the flap, in a crescent shape of skin in the perialar area, allowing the mobilization of the skin of the lateral surface of the nose and cheek. METHODS: Eleven patients presenting tissue loss from the tip of the nose after excision of carcinoma underwent surgery using the flap. RESULTS: The flap described constitutes a good alternative for reconstruction of nasal tip defect, up to 2 cm of diameter, with excellent aesthetic results. CONCLUSION: Numerous flap options are available to reconstruct tissue loss from the tip of the nose. The nasojugal flap we describe, due to its great reliability, yields excellent functional and cosmetic results, and we believe that it is a valuable alternative to other techniques of reconstruction for defect of the nasal tip. For the 11 patients who underwent surgery with this flap, no major complication was reported. The aesthetic result was never compromised, and the scars result was very satisfactory.     

The Rhombic Bilobed Flap for Nasal Reconstruction

BACKGROUND: The bilobed flap is a useful tool for reconstruction of the nose but is occasionally complicated by pincushioning or trapdoor deformity. OBJECTIVE: To describe the use of a rhombic bilobed flap for use in reconstructing defects on the lower third of the nose. METHODS: Reconstruction of skin cancer defects following Mohs surgery was performed using a bilobed rhombic flap design in 10 patients. RESULTS: Good to excellent results were seen in 9 of 10 patients. Significant pincushioning was not present postoperatively in any patient. CONCLUSION: Despite some disadvantages, the rhombic bilobed flap is useful in reconstructing nasal defects on the lower third of the nose.