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DOI: 10.1055/s-0031-1275776
Total Nasal Reconstruction: A 6-Year Experience with the Three-Stage Forehead Flap Combined with the Septal Pivot Flap
Publication History
Publication Date:
12 May 2011 (online)
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ABSTRACT
Several different methods can be applied for repairing total nasal defects. Most of them are based on some common principles and techniques widely accepted and adopted by experienced surgeons. We have been using most of these techniques during the past two decades, however modifying and refining them several times. Our observations and sometimes disappointing experiences led to a concept that has remained unchanged for the past 6 years. It comprises three regular operative steps and sometimes a fourth surgical intervention for repair and refinement. First stage: Reconstruction of the septum using a bipedicled composite septal pivot flap (SPF), of the intranasal lining (INL), and the cover being established by elevating a full-thickness paramedian forehead flap (PMFF). Second stage: Re-elevation of the PMFF, thinning of its layers, and reconstruction of the subsurface framework using autogenous rib cartilage. Third stage: Division of the pedicle and minor corrections. We have been using this technique presented here since 2004 in nine consecutive patients with subtotal to supratotal nasal defects. Seven cases have been repaired completely by now and can be evaluated carefully. With this technique, results have significantly improved and have been stable to date.
KEYWORDS
Total nasal reconstruction - operative technique
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Joachim QuetzM.D.
Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-Universität zu Kiel
Arnold-Heller-Strasse 3 (Haus 27), D-24105 Kiel, Germany
Email: quetz@hno.uni-kiel.de