J Rhinol.  2017 Nov;24(2):132-137. 10.18787/jr.2017.24.2.132.

Reconstruction of Subtotal Nasal Defect with Radial Forearm Free Flap and Forehead Flap: A Case Report

• Han YE
• Lim HJ
• Jeong EC
• Jin HR

• KMID: 2398833
• DOI: http://doi.org/10.18787/jr.2017.24.2.132

Abstract

Reconstructive rhinoplasty is one of the unique areas of rhinoplasty, but its concept and technique have not been widely established in Korea compared to cosmetic rhinoplasty. Nasal reconstruction poses a challenging problem when the defect is large and involves all 3 layers of the nose including the septum. We report a patient who underwent nasal reconstruction due to subtotal, full thickness defect of the nose after repeated failed rhinoplasties including use of a nasolabial flap. A staged operation was planned. First, a radial forearm free flap was used to reconstruct the inner layer. After 4 months, the bulk of the forearm tissue was reduced and used as inner lining at the second operation. In the second operation, the framework of the lower 2/3 of the nose was formed of autologous rib cartilage, and the outer skin defect was covered with a forehead flap. Six weeks later, the forehead flap was divided. One year after the last operation, the patient can breathe well, and his nose has better esthetics than before surgery. We believe this is the first report of nasal reconstruction using a radial forearm free flap and a forehead flap to restore a subtotal, full thickness defect of a nose.

Keyword

Reconstructive rhinoplasty; Radial forearm free flap; Forehead flap

MeSH Terms

Cartilage
Esthetics
Forearm*
Forehead*
Free Tissue Flaps
Humans
Korea
Nose
Rhinoplasty
Ribs
Skin

Figure

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  Fig. 1 Pre-operative findings. Cartilaginous dorsum, tip, and ala are deformed and collapsed into the nasal cavity obstructing the nasal airway (A–D). Endoscopic view of the nasal cavity. A large septal perforation is observed (E).

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  Fig. 2 1st stage operation. A harvested radial forearm tissue bulk is ready to be transferred to the defect. Note the long vessel pedicle which will be passed through the subcutaneous tunnel from the nose to the right submandibular incision (A). 2.5 months after surgery, bulky and healthy forearm flap is covering the nasal defect (B). The donor site of radial forearm flap is well healed after skin graft (C).

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  Fig. 3 Operative findings of the 2nd stage operation. The subcutaneous fat of the forearm flap is being excised. Note the new skin marking for dorsal skin excision considering the aesthetic subunit principle (A). The nasal framework is created with autologous rib cartilage grafts. Note the L-strut reconstructed with combination of dorsal graft and extended columellar strut, the alar contouring grafts, and the sidewall grafts (B). The skin defect is covered with forehead flap (C). A week after 2nd surgery, the flap covering the defect looks healthy. Note that the distal part of the flap donor site is left uncovered for secondary healing (D).

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  Fig. 4 Post-operative result at 7 months after three-staged operation. Nasal form and function improved much compared with preoperative status. The inner lining is intact, the nostrils are open, the framework maintains its shape, and the outer lining matches well with surrounding skin. Note that the forehead scar is minimal even with secondary healing of the distal part.

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