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Arch Plast Surg. 2013 Nov;40(6):748-53. doi: 10.5999/aps.2013.40.6.748. Epub 2013 Nov 8.

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

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1
Department of Plastic and Reconstructive Surgery, University of Florence, Faculty of Medicine and Surgery, Florence, Italy.

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.

KEYWORDS:

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

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