Reconstruction of a subtotal septorhinectomy defect with a chimeric paramedian-pericranial forehead flap

Case Report: A new variant of the forehead flap for subtotal nose reconstruction in a single stage: the dragonfly flap

Background

The forehead flap is probably the most used method for nose reconstruction after cancer resection. During the past century, this technique has been continuously refined to achieve better functional and aesthetic outcomes. Different variations have been described, with the original technique being modified based on tissue loss, the layer to be replaced, and the management of the donor area.

Methods

We propose a new and innovative version of the forehead flap in which both the forehead skin and the frontal muscle are harvested simultaneously using the same vascular pedicle. Partially separating the two layers allows muscle tissue to replace the inner layer and cover the nasal septum framework, while the skin will replace the outer layer. The nostrils are reconstructed simultaneously using bilateral hinge-over lining skin flaps harvested from the nasal folds.

Results

Step by step, a schematic illustration of the technique is given, followed by a complete report on a successful total nose reconstruction case.

Conclusions

Despite the increasing number of techniques which have been introduced to achieve full reconstruction of the nose, including microsurgical tissue transfer, the simultaneous replacement of both the inner and outer layers continues to be an issue for the plastic surgeon. In this article, we suggest a solution for total nose reconstruction in a single-stage procedure.

Total Nasal Reconstruction: Advances in Free Tissue Transfer for Internal Lining and Structural Support

Total nasal reconstruction is a complex challenge due to the need to establish new internal lining, internal structural support, and external skin covering that is both functional and esthetic. The medial femoral condyle corticoperiosteal free flap represents an innovative option for restoration internal structure and internal nasal lining. When used in conjunction with a paramedian forehead flap, acceptable results in both function and esthetics can be achieved.

Total nasal reconstruction: a review of the past and present, with a peak into the future

PURPOSE OF REVIEW

The goal of this article is to review the complex topic of total nasal reconstruction and present a wide range of options for completing this difficult surgical procedure.

RECENT FINDINGS

Nasal reconstruction has a long history dating back thousands of years. Some historical techniques still exist today, including the paramedian forehead flap. The introduction of free tissue transfer and other pedicled flaps has provided multiple options for the reconstructive surgeon. The future of nasal reconstruction will include facial transplantation and likely bioengineered tissues.

SUMMARY

The principles of nasal reconstruction have gone unchanged for decades; however, the techniques to meet the principles have. The current reconstructive methods of grafts, free flaps, and pedicled flaps used to replace lining, structure, and skin will likely be used for several years to come. However, the use of facial transplantation has proved effective and bioengineered tissues present an exciting future for organ replacement.