Arch Plast Surg.  2013 Nov;40(6):748-753. 10.5999/aps.2013.40.6.748.

Through-and-through Nasal Reconstruction with the Bi-Pedicled Forehead Flap

• Agostini T
• Perello R
• Russo GL
• Spinelli G

• KMID: 2167863
• DOI: http://doi.org/10.5999/aps.2013.40.6.748

Abstract

BACKGROUND
Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction.
METHODS
Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia.
RESULTS
Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary.
CONCLUSIONS
This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.

Keyword

Nose neoplasms; Nose deformities, acquired; Surgical flaps; Nasal surgical procedures; Nasal bone

MeSH Terms

Cheek
Forehead*
Frozen Sections
General Surgery
Head
Humans
Microsurgery
Nasal Bone
Nasal Surgical Procedures
Neck
Nose Deformities, Acquired
Nose Neoplasms
Orbit
Skin
Surgical Flaps