Outcomes, Concepts, Technical Refinements, and Challenges in the Microvascular Repair of Full-Thickness Nasal Defects

Abstract

Background: Repair of full-thickness nasal defects may require distant tissue, when local or regional donors are inadequate or unavailable. The authors’ microvascular designs, technical details, and complications using a radial forearm flap to restore nasal lining have been described in past publications. In this article, the authors review stages 2 through 5, using a forehead flap and rib grafts to resurface the nose and build a support framework. The authors examine their complications, long-term aesthetic and functional outcomes, clinical refinements, and continuing reconstructive challenges. Methods: Thirty-eight full-thickness nasal defects were repaired between 2001 and 2018. Records review identified the type and frequency of complications and their management. Patients were surveyed to determine their overall satisfaction, quality of life, restoration to a normal appearance, donor scars, the value of a late revision, airway function, and need for nasal stents. Postoperative results were classified by independent evaluators as very good, good, fair, and poor. Results: Repair was completed in 35 of 38 patients. Fifty percent of patients returned an anonymous survey; 85% were very satisfied; 75% declared excellent, very good, or good breathing; 75% used stents never/rarely; 95% appeared normal; and 95% would recommend to other patients. An independent review classified the aesthetic results as 94% very good to good, 3% fair, and 3% poor. Conclusion: A folded radial forearm lining flap, a three-stage full-thickness forehead flap for cover, and a late revision can repair difficult nasal defects, as shown in a large series of patients with long-term follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.