Facial Plast Surg 2017; 33(01): 074-081
DOI: 10.1055/s-0036-1597984
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microvascular Flaps in Nasal Reconstruction

Irene A. Kim
1   Department of Facial Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
,
Kofi D. O. Boahene
2   Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institute, Baltimore, Maryland
,
Patrick J. Byrne
2   Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institute, Baltimore, Maryland
,
Shaun C. Desai
3   Division of Facial Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
22 February 2017 (online)

Abstract

Nasal reconstruction for subtotal and total rhinectomy defects is a challenging endeavor, which requires technical finesse, a keen artistic eye, and the ability to anticipate long-term changes that accompany postoperative healing. While local and regional flaps have traditionally been utilized to reconstitute missing nasal elements, certain situations may not provide sufficient or acceptable tissue for optimal reconstruction. In these situations, the three major components of the nose—lining, structural support, and external skin—may require reconstruction with tissues harvested from distant sites through microvascular free tissue transfer. Our objective in this article is to discuss the general approach to nasal reconstruction and present the considerations for free tissue transfer with regard to each nasal component. The virtues of free flap transfer as well as its shortcomings and potential complications are discussed.

 
  • References

  • 1 Cannady SB, Cook TA, Wax MK. The total nasal defect and reconstruction. Facial Plast Surg Clin North Am 2009; 17 (2) 189-201
  • 2 Seth R, Revenaugh PC, Scharpf J, Shipchandler TZ, Fritz MA. Free anterolateral thigh fascia lata flap for complex nasal lining defects. JAMA Facial Plast Surg 2013; 15 (1) 21-28
  • 3 Winslow CP, Cook TA, Burke A, Wax MK. Total nasal reconstruction: utility of the free radial forearm fascial flap. Arch Facial Plast Surg 2003; 5 (2) 159-163
  • 4 Tollefson TT, Kriet JD. Complex nasal defects: structure and internal lining. Facial Plast Surg Clin North Am 2005; 13 (2) 333-343 , vii
  • 5 Taghinia AH, Pribaz JJ. Complex nasal reconstruction. Plast Reconstr Surg 2008; 121 (2) 15e-27e
  • 6 Antunes MB, Chalian AA. Microvascular reconstruction of nasal defects. Facial Plast Surg Clin North Am 2011; 19 (1) 157-162
  • 7 Burget GC, Walton RL. Optimal use of microvascular free flaps, cartilage grafts, and a paramedian forehead flap for aesthetic reconstruction of the nose and adjacent facial units. Plast Reconstr Surg 2007; 120 (5) 1171-1207 , discussion 1208–1216
  • 8 Menick F. Nasal Reconstruction: Art and Practice. Arizona: Elsevier; 2008: 720-792
  • 9 Walton RL, Burget GC, Beahm EK. Microsurgical reconstruction of the nasal lining. Plast Reconstr Surg 2005; 115 (7) 1813-1829
  • 10 Moore EJ, Strome SA, Kasperbauer JL, Sherris DA, Manning LA. Vascularized radial forearm free tissue transfer for lining in nasal reconstruction. Laryngoscope 2003; 113 (12) 2078-2085
  • 11 Park SS, Cook TA, Wang TD. The epithelial ‘turn-in’ flap in nasal reconstruction. Arch Otolaryngol Head Neck Surg 1995; 121 (10) 1122-1127
  • 12 Sinha M, Scott JR, Watson SB. Prelaminated free radial forearm flap for a total nasal reconstruction. J Plast Reconstr Aesthet Surg 2008; 61 (8) 953-957
  • 13 Ohmori K, Sekiguchi J, Ohmori S. Total rhinoplasty with a free osteocutaneous flap. Plast Reconstr Surg 1979; 63 (3) 387-394
  • 14 Revenaugh PC, Haffey TM, Seth R, Fritz MA. Anterolateral thigh adipofascial flap in mucosal reconstruction. JAMA Facial Plast Surg 2014; 16 (6) 395-399
  • 15 Upton J, Ferraro N, Healy G, Khouri R, Merrell C. The use of prefabricated fascial flaps for lining of the oral and nasal cavities. Plast Reconstr Surg 1994; 94 (5) 573-579
  • 16 Kobayashi S, Yoza S, Sakai Y, Ohmori K. Versatility of a microsurgical free-tissue transfer from the forearm in treating the difficult nose. Plast Reconstr Surg 1995; 96 (4) 810-815
  • 17 Koshima I, Tsutsui T, Nanba Y, Takahashi Y, Akisada K. Free radial forearm osteocutaneous perforator flap for reconstruction of total nasal defects. J Reconstr Microsurg 2002; 18 (7) 585-588 , discussion 589–590
  • 18 Menick FJ. A new modified method for nasal lining: the Menick technique for folded lining. J Surg Oncol 2006; 94 (6) 509-514