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.
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References
Gillies HD (1920) Plastic surgery of the face. Frowde, Hodder, & Stoughton: London, pp. 270–273
Gillies HD, Millard DR (1957) The principles and art of plastic surgery. Little, Brown: Boston, pp. 104–110
Frederick J, Menick A (2002) 10-Year experience in nasal reconstruction with the three-stage forehead flap. Plast Reconstr Surg 109:1839
Bayramicli M (1996) The distal dorsalis pedis flap for nasal tip reconstruction. Br J Plast Surg 49:325–327
Walton RL, Burget GC, Beahm EK (2005) Microsurgical reconstruction of the nasal lining. Plast Reconstr Surg 115:1813
Bayramicli M (2006) A new classification system and an algorithm for the reconstruction of nasal defects. J Plast Reconstr Aesthet Surg 59:1222–1232
Mutaf M, Ustuner ET, Celebioglu S, Kocer U, Sensoz O (1995) Tissue expansion—assisted prefabrication of the forehead flap for nasal reconstruction. Ann Plast Surg 34:478–484
Pribaz JJ, Falco N (1993) Nasal reconstruction with auricular microvascular transplant. Ann Plast Surg 31:289
Erol OO (1976) Transformation of a free skin graft into vascularized pedicled flap. Plast Reconstr Surg 58:470
Yotsuyanagi T, Yamashita K, Urushidate S, Yokoi K, Sawada Y (2000) Nasal reconstruction based on aesthetic subunits in orientals. Plast Reconstr Surg 106:36
Burget GC, Menick FJ (1985) The subunit principle in nasal reconstruction. Plast Reconstr Surg 76:239
Millard DR Jr (1976) Reconstructive rhinoplasty for the lower two-thirds of the nose. Plast Reconstr Surg 57:722–728
Tellioglu AT, Tekdemir I, Saray A, Eker E (2005) Reconstruction of proximal nasal defects with ısland composite nasal flaps. Plast Reconstr Surg 115:416
Barton FE, Byrd HS (1990) Acquired deformities of the nose. Plast Surg 3:1925–2008
Strauch B, Fox M (1989) V-Y Bipedicle flap for resurfacing the nasal supratip region. Plast Reconstr Surg 83:899
Marchac D, Toth B (1985) The axial frontonasal flap revisited. Plast Reconstr Surg 76:686
Maruyama Y, Iwahira Y (1997) The axial nasodorsum flap. Plast Reconstr Surg 99:1873
Ogino Y (1985) The technical advances in the reconstructive rhinoplasty. In: Meyers E (ed) New dimensions in oto-rhino-laryngology: Head and neck surgery. Vol. 1. Excerpta Medica: Amsterdam, pp. 619–622
Uchinuma E, Matsui K, Shimakura Y, Murashita K, Shioya N (1997) Evaluation of the median forehead flap and the nasolabial flap in nasal reconstruction. Aesth Plast Surg 21:86
Kroll SS, Rosenfield L (1989) Delayed pedicle separation in forehead flap nasal reconstruction. Ann Plast Surg 23:327–334
Kroll SS (1989) Forehead flap nasal reconstruction with tissue expansion and delayed pedicle separation. Laryngoscope 99:448–452
Burget GC (1995) Invited discussion of tissue expansion–assisted prefabrication of the forehead flap for nasal reconstruction. Ann Plast Surg 34:485–487
Burget GC, Menick FJ (1986) Nasal reconstruction: Seeking a fourth dimension. Plast Reconstr Surg 78:145
Burget GC, Menick FJ (1989) Nasal support and lining: The marriage of beauty and blood supply. Plast Reconstr Surg 84:189
Baker SR (1998) Nasal lining flaps in contemporary reconstructive rhinoplasty. Facial Plast Surg 14:133
Soutar DS, Elliott D, Rao GS (1990) Buccal mucosal flaps in nasal reconstruction. Br J Plast Surg 43:612
Pribaz J, Stephens W, Crespo L, Gifford G (1992) A new intraoral flap: Facial artery musculomucosal (FAMM) flap. Plast Reconstr Surg 90:421
Jackson IT, Reid CD (1978) Nasal reconstruction and lengthening with local flaps. Br J Plast Surg 31:341
Iida N, Ohsumi N, Tsutsumi Y, Tonegawa M (2000) The full-thickness retroangular flap. Ann Plast Surg 45:544
Park SS, Cook TA, Wang TD (1995) The epithelial “turn-in” flap in nasal reconstruction. Arch Otolaryngol Head Neck Surg 121:1122
Winslow CP, Cook TA, Burke A, Wax MK (2003) Total nasal reconstruction: Utility of the free radial forearm fascial flap. Arch Facial Plast Surg 5:159
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Alagöz, M.Ş., İşken, T., Şen, C. et al. Three-Dimensional Nasal Reconstruction Using a Prefabricated Forehead Flap: Case Report. Aesth Plast Surg 32, 166–171 (2008). https://doi.org/10.1007/s00266-007-9026-5
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DOI: https://doi.org/10.1007/s00266-007-9026-5