Composite Cartilage-osseous-mucosal Nasoseptal Flap for Reconstruction after Near Total Rhinectomy. (January 2021)

• Record Type: Journal Article
• Authors: Shastri, Karthik S.; Lin, Yufan; Scordino, Jessica; Pinheiro-Neto, Carlos D.
• Is Part Of: Annals of otology, rhinology & laryngology. Volume 130:Number 1(2021)
• Page Start: 98
• Page End: 103
• Publication Date: 2021-01
• Subjects: complex nasal reconstruction -- facial plastic surgery -- otolaryngology -- nasoseptal flap -- miscellaneous -- melanoma miscellaneous -- pedicled flaps -- nasal and sinus surgery; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0003489420935481
• Languages: English
• ISSNs: 0003-4894

Abstract

Background: Reconstruction of full thickness nasal defects usually requires different donor sites for the external skin envelope, structural elements, and internal nasal lining. In this paper we present a novel single site method for dual inner lining and skeleton repair for full thickness nasal defects with a composite nasoseptal flap and extended pedicle dissection. Methods: A 72-year-old male presented with a T4b melanoma involving the nasal dorsum and left upper lateral cartilage. Following full thickness resection, reconstruction was performed with a nasoseptal flap (NSF) with attached septal cartilage and vomer in conjunction with a paramedian forehead flap. Extended pedicle dissection into the pterygopalatine fossa allowed the NSF to fully cover the defect. Results: The nasal defect was fully corrected. There was no evidence of flap compromise or nasal valve stenosis at 1 month, 2 month, and 1 year follow-up visits. Conclusions: We present here the first successful application of a composite cartilage-osseous-mucosal NSF for multilayered nasal reconstruction. In appropriate patients, this technique may obviate the need for flaps or grafts from extranasal sources, limiting donor site morbidity.