Cutaneous Reconstruction of the Nasal Distal Third: Alternative Local Flaps for a Complex Region

Local Random Pattern and Axial Flaps for Reconstruction of Nasal Surgical Defects: Retrospective Analysis with an Attempt to Inspire ENT Surgeons

Aim: Reconstruction of the surgical defects of the external nose has been challenging and largely considered to be the domain of plastic reconstructive surgeons. The present study aims to share our experience in reconstructing such defects. Materials and methods: A retrospective analysis of 11 patients who underwent external nasal reconstruction secondary to surgical defect at our otolaryngology department in a tertiary care hospital from 2017 to 2019 was done. All the patients underwent surgical excision of a part of the external nasal dorsum followed by reconstruction by our team of otolaryngology surgeons using local random pattern/ axial flaps. The patients were followed up postoperatively for a period ranging from 3 months (for benign pathologies) to 2 years (malignant pathologies). Results: The flaps were taken up in all the patients. Minor complications like postoperative infection were seen in 2 cases, resulting in wound dehiscence in one that required resuturing that was uneventful. The appearance was bulky in all the patients, although the patients were satisfied with the overall cosmetic appearance. The average hospital stay was 2 to 4 days. Conclusion: Reconstruction of external nasal surgical defects is a challenging task. Thorough knowledge of relevant anatomy, proper planning, and availability of abundant vascularized donor tissue in the near vicinity of the defect makes this challenge acceptable with good outcomes even in the hands of otolaryngologists.

Using the Helical Free Flap Based on the Retrograde Flow From Frontal Branch of Superficial Temporal Vessels in Lower Third Nasal Reconstruction

ABSTRACT

Although the helical free flap is 1 of the most effective option for the lower third nasal reconstruction, the main limitation is still related to having a short pedicle length. In this report, the authors presented our experience in using the long pedicle helical free flap based on the frontal branch of the superficial temporal vessels in nasal reconstruction. Five patients, 3 alar full-thickness defects, 1 columellar defect, and 1 multiple subunit defect, underwent reconstruction using this technique. The pedicle length ranged from 4 to 6 cm. All the flaps were survived completely. However, vein congestion was seen post-operation in 1 case. This flap was saved by using medical leech. No vascular graft was needed. The helical free flap based on the retrograde flow of the frontal branch of the superficial temporal artery offers an option to overcome the limitation of short pedicle length. This composite flap is valuable for nasal alar and columellar reconstruction or even the larger defects, which involve multiple subunits.