Forehead Flap Nasal Reconstruction is used in the reconstruction of the nasal bone, cartilage, skin and mucosa. The cause can be congenital or from mechanical trauma, chemical trauma, or vascular injury. Mechanical trauma is usually from car, bicycle, or other accidents. It can also result from complications after surgery. Chemical irritants can atrophy the mucosa lining of the septum. As a result, cartilage exposure, breakdown, and eventual collapse of the cartilaginous bridge of the nose can occur. Cocaine abuse is a common example. This condition is typically termed the cocaine nose. It can include a saddle nose deformity. Other causes include vascular compromise. Injection of fillers in the soft tissues around the nose can lead to this complication. If the filler is placed too aggressively, it can cause infarction of the surrounding tissue. This leads to skin necrosis and deformity.
When addressing a complex nasal reconstruction, it is crucial to analyze the defect first. One must decide which tissues need reconstruction. These include the inner lining of the nose, the cartilage and bone, and the overlying skin. Because of the multiple layers needing reconstruction, total nasal reconstruction typically involves multiple stages as follows:
Steps in Forehead Flap Nasal Reconstruction
- First stage: obtaining tissue for lining of the nose usually from a forehead flap that is folded to give internal lining as well as outer skin cover
- Second stage: Once the first stage has healed, the flap is reelevated. Structural support for the nose is added. This is typically done using a rib graft. The rib graft can offer dorsal support and columellar support for adequate tip projection. The forehead flap can also be thinned in this stage to guarantee a nice contour to the nose.
- Third stage: The forehead flap is divided and inset. Small cartilage grafts from the ear can be used to help correct any contour irregularities in this stage.
- Fourth Stage: Small refinements that can be done under local anesthesia are usually needed to complete an aesthetic reconstruction.
Visit us at Thomassen Plastic Surgery to learn how Total Nasal Reconstruction can help you.
Learn more about nasal reconstruction at the American Society of Plastic Surgery website.