8.23 Xeroform is placed over stitches as final dressing.
In regard to function, 2 of 16 patients complained of nasal obstruction related to the reconstruction. 8.8 Reverse Gilles test is performed to ensure adequate flap length. Inferiorly, the incision is made into the subcutaneous tissues superficial to the muscular plane (Figure 1).
In columella-only defects, the 3 mentioned flaps can he used. The forehead flap was also used to resurface the entire nasal columella, tip.
8.9 Flap is sharply elevated to the level of the nasal ala. Care is taken to protect any perforating vessels at the base of the flap. Hemostasis is achieved at the base of the flap. CASE 1 Fig.
and P.A.H.) The flap selection between nasolabial flap and paramedian forehead flap is dictated primarily by surgeon’s preference, but the flaps should not be considered interchangeable.
This study was a retrospective medical chart review of patients who had undergone nasal reconstruction involving the nasal columella by 2 of us (D.A.S.
General traction is placed to prevent oversizing the flap. We thank Denise Rogers for her help in collecting patient information and Kelly Amunrud for manuscript preparation.
between January I , 1982, and December 31 , 2000.
The medial crura can be reconstituted with an autogenous cartilage graft wrapped within the flap. Advantages of the nasolabial flap include technically simpler flap harvest, the ability to harvest under local or intravenous sedation only, and much easier postoperative wound care. The nasal floor transposition flap for repairing distal nose/columella defects. In some cases, 50% of the subunit was resected, especially in combination with the tip sub-unit, and the rest of the columellar subunit was left in-tact. He underwent a Mohs micrographic resection, which resulted in a full-thickness defect of the anterior one third of the septum, entire nasal columella, nasal tip, and middle one third of the upper lip (Figure 6).
Laryngoscope. If necessary, the entire nasal unit is dermabraded approximately 4 to 6 weeks after the original reconstruction. The pedicle is excised and closed in the nasolabial crease.
1983;10:635-647. Fig. Objective: To report techniques successful for nasal columella reconstruction. A transposition flap is cut, lifted, and transferred over intervening tissue onto the defect. Ozkus I, Cek DI, Ozkus K. The use of bifid nasolabial flaps In the reconstruction of the nose and columella.
When the columellar and tip nasal subunits, with or without other adjacent nasal subunits, are involved in the defect, the forehead flap is the best reconstruction option. NASOFACIAL SULCUS FLAP TECHNIQUE Some authors support the use of chondrocutaneous composite auricular grafts for composite columellar defects. (e,f) The cheek is meticulously closed, but care is taken to avoid compression of the pedicle. Nasolabial flaps are suitable for patients with a distinct nasolabial fold and cheek redundancy and who have either ala, tip, or soft triangle defects with intact lining. 2 After the vertical and horizontal dimension of the flap is determined, the flap is designed again with the cheek placed under mild stretch to avoid oversizing. Three patients had no photo-graphs, and 1 patient had a photograph only of the defect.
They found that changes in soft tissue and bony contours of the nose resulted in distinct, consistent nasal subunits, including the dorsum, tip, columella, 2 lateral side walls, 2 alae, and 2 soft tissue triangles! The forehead flap probably has the best vascularity, with an axial supply by the supratrochlear vascular bundle, and may be the flap of choice in smokers or in patients in whom vascularity issues are a concern. The flap is trimmed on inset (▶ Fig. That said, the aesthetic results of these reconstructions not only equaled the predefect appearance but also showed an apparent improvement in the nasal aesthetics in all cases. Auditing free text in an electronic medical record. After the skin island was pulled through the nostril sill, it was wrapped around an auricular cartilage graft, which was used as a columellar strut.
Hard Headed Provider, Messy Situation !!!! *Data are given as score between 1 and 10. He had no nasal obstruction and no other notable medical or surgical history. 1995:105:1141-1143. 8.18, ▶ Fig.
8.10, ▶ Fig.
Join from wherever you are in the world. The impact of Indian methods for total nasal reconstruction.
The nasolabial flap is incised through the skin, with the distal end elevated in the sub-cutaneous plane above the facial musculature. 99213 for a wound infection - need modifier? Fig. In women or in men with light facial hair, the nasolabial flap is excellent to reconstruct the columella and the caudal septal mucosa. The subunit principle in nasal reconstruction. Occasionally, minor revision of the reconstructed area is per-formed 3 months to 1 year later. Pedicle on cheek is completely excised and resulting wound closed with 3–0 Vicryl and 6–0 nylon. 8.15). The cartilaginous structure of the nose is re-constructed with autogenous cartilage grafts. This is a new flap technique developed by one of us (P.A.H.).
After reconstruction, 4 had photographs of the defect and after reconstruction, 4 had all 3 (before, defect, and after) photographs, and 1 had photographs only after reconstruction.
Flap is coated in nitropaste.
The mean documented follow-up of the patients was 17.2 months (range, 1-30 months) following reconstruction.
The flap is thus shaped somewhat like a banana. 8.2, ▶ Fig. Surgical options in columellar reconstruction.
This articles focuses on the reconstruction of the nasal columellar subunit. For the nasolabial flap design, the only sizing decision is the height of the defect. 8.20 The border of the defect is marked to determine flap outline for inset and flap is then sharply cut to size and shape. We reviewed columella reconstructions performed by 2 of us (D.A.S. Fig. Dissection inferior to the flap is performed in the superficial subcutaneous tissue with primarily blunt dissection to avoid injury to the facial artery and vein. Complications resulting from the reconstructions included nostril stenosis, 3; metastasis, 2; decreased function, 2; and corneal abrasions, I . An incision is then made along the ipsilateral nostril sill, and a subcutaneous tunnel is created that connects to the tunnel adjacent to the alar crease (Figure 2). 8.24).
To our knowledge, this study represents the largest collection of columella reconstruction cases in the literature. Dolan R, Arena S. Reconstruction of the total columellar defect. Rurget GC, Menick FJ. The do-nor site is closed by advancing a cheek flap to the nasolabial groove.
An incision was then made along the right nostril sill, and a subcutaneous tunnel was created that connected to the tunnel adjacent to the alar crease. 8.18 Pedicle on cheek is completely excised and resulting wound closed with 3–0 Vicryl and 6–0 nylon.
This was then divided using a #15 blade.
1 The absence of a nasolabial fold is an absolute contraindication to elevation of a nasolabial flap as the scarring will be unacceptable.
A 72-year-old female patient status post Mohs excision for basal cell carcinoma at right ala. Alar rim cartilage graft is harvested from anterior conchal bowl incision. The facial artery, vein, and investing muscular tissues are isolated as far inferiorly as the alar crease. 1985:76:239-247.
A score of 0 represented the worst appearance and 10, the best. The flaps are reliable and the results are acceptable with respect to aesthetics and function. Methods: Retrospective medical chart review of patients undergoing columella reconstruction by 2 of us (D.A.S.
The results of the reconstructions were scored on a 0- to 10-cm visual analogue scale (Table 4).
The mean improvement on the 10-cm visual analogue scale was 2.0 from before tumor resection or trauma to after re-construction, and 5.0 from tumor resection or trauma to after reconstruction. In addition, the recipient bed for the composite graft would typically be only moderately vascular, like the caudal septum or opposite medial crural feet, and might not support the graft. The paramedian forehead flap is centered on the supratrochlear artery contralateral to the defect; Doppler ultrasonography can be used to identify the vessel.
A panel of experienced facial surgeons, excluding us, was shown photographs of the nose before and after surgery and was asked to rate the nasal aesthetics on a 10-cm visual analogue scale, with a specific focus on the columella.
Final cheek closure achieved with 5–0 nylon.
Two to three weeks later, the pedicle is divided and the flap is thinned and inset.
Nichter LS, Morgan RF, Nichter MA. Quatela VC, Sherris DA, Rounds MF. 8.1 (a,b) The vertical height of the defect is transferred to the cheek with the inferior margin being the nasolabial fold. The flap is dressed with fibrillar collagen immediately postoperatively and the pedicle donor site deliberately packed with either fibrillar collagen or sterile cotton for hemostasis and the patient is instructed to simply shower away the dressings on the third postoperative day and then the flap is treated with just petroleum ointment until it is divided between the third and fourth weeks. The donor site is closed primarily.
In conclusion, our results demonstrate that the paramedian forehead flap, nasolabial flap, and nasofacial sulcus flap can be used to effectively reconstruct the nasal columella. Arch Otolaryngol Head Neck Surg. If the defect is larger than 1.5cm,especiallyifwithin0.5to1cmofthenostril Large donor defects may be closed partially and the resulting defect allowed to close by secondary-intention healing over several weeks. Several techniques are described, along with follow-up information regarding the reconstructions.
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