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CC BY 4.0 · Arch Plast Surg 2024; 51(05): 480-486
DOI: 10.1055/a-2337-2131
Pediatric/Craniomaxillofacial/Head & Neck: Idea and Innovation

A Lifeboat for Failed Nasal Reconstructions: The Supraclavicular–Submental Sandwich Flap

Michel L.H.T. Vaena 
1   Faculdade de Ciências Médicas (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
,
Kevin Sicalo 
2   Hospital Universitario Pedro Ernesto, UERJ, Rio de Janeiro, RJ, Brazil
,
Caterina Goulart Alessio 
2   Hospital Universitario Pedro Ernesto, UERJ, Rio de Janeiro, RJ, Brazil
,
Eduardo Pantoja Bastos 
2   Hospital Universitario Pedro Ernesto, UERJ, Rio de Janeiro, RJ, Brazil
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Abstract

Many failures in total or subtotal nasal reconstruction result from an underestimation of the amount of skin required for an adequate result, especially for sufficient lining. Such planning errors usually lead to poor results, with exposure of structural grafts, infection, scar retraction, airway obstruction, and finally loss of projection and shape of the reconstructed nose. Reconstruction options for cases in which previous attempts have failed are always limited, as well as in cases of trauma or burns affecting the soft tissues of the forehead and face. In such complex situations, one may employ free flaps or tissue expansion, but such resources may not be always available. We describe a technique indicated for salvage surgeries in patients whose previous nasal reconstructions have failed, allowing a generous amount of tissue transfer for the nasal region. The technique combines the use of supraclavicular and submental flaps, with simple execution, not requiring microsurgical skills or devices such as tissue expanders. Done in three stages, the described technique provides enough skin for a total nasal reconstruction. The final result is obtained after subsequent refinements, and the total number of procedures is equivalent to when more sophisticated techniques are employed, such as tissue expansion or microsurgery.

Keywords

surgical flaps - reconstructive surgical procedures - nose deformities - acquired

Authors' Contributions

ML.H.T.V.: conceptualization, project administration, writing original draft, reviewing, and editing. K.S./C.G.A.: visualization, data curation, and writing original draft. E.P.B.: visualization, data curation, and project administration.


Ethical Approval

This study was study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the Institutional Review Board of Pedro Ernesto University Hospital (No. 5.746.423: the registration number of the ethics board).


Patient Consent

The patients' consent was obtained for their clinical photographs and videos for academic purposes.




Publication History

Received: 19 September 2023

Accepted: 30 May 2024

Accepted Manuscript online:
03 June 2024

Article published online:
09 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Whitaker IS, Karoo RO, Spyrou G, Fenton OM. The birth of plastic surgery: the story of nasal reconstruction from the Edwin Smith Papyrus to the twenty-first century. Plast Reconstr Surg 2007; 120 (01) 327-336
    CrossrefPubMedGoogle Scholar
  • 2 Marck KW, Palyvoda R, Bamji A, van Wingerden JJ. The tubed pedicle flap centennial: its concept, origin, rise and fall. Eur J Plast Surg 2017; 40: 473-478
    CrossrefGoogle Scholar
  • 3 Lamberty BGH. The supra-clavicular axial patterned flap. Br J Plast Surg 1979; 32 (03) 207-212
    CrossrefPubMedGoogle Scholar
  • 4 Pallua N, Magnus Noah E. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg 2000; 105 (03) 842-851 , discussion 852–854
    CrossrefPubMedGoogle Scholar
  • 5 Patel UA, Bayles SW, Hayden RE. The submental flap: a modified technique for resident training. Laryngoscope 2007; 117 (01) 186-189
    CrossrefPubMedGoogle Scholar
  • 6 Martin D, Pascal JF, Baudet J. et al. The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap. Plast Reconstr Surg 1993; 92 (05) 867-873
    CrossrefPubMedGoogle Scholar
  • 7 Krauss M. Reconstruction of subtotal defects of the nose by abdominal tube flap. Br J Plast Surg 1964; 17: 70-75
    CrossrefPubMedGoogle Scholar
  • 8 Gasteratos K, Spyropoulou GA, Chaiyasate K. Microvascular reconstruction of complex nasal defects: case reports and review of the literature. Plast Reconstr Surg Glob Open 2020; 8 (07) e3003
    CrossrefPubMedGoogle Scholar
  • 9 Menick FJ, Salibian A. Outcomes, concepts, technical refinements, and challenges in the microvascular repair of full-thickness nasal defects. Plast Reconstr Surg 2023; 151 (06) 1002e-1014e
    Google Scholar
  • 10 Rezaeian F, Corsten M, Haack S, Gubisch WM, Fischer H. Nasal reconstruction: extending the limits. Plast Reconstr Surg Glob Open 2016; 4 (07) e804
    CrossrefPubMedGoogle Scholar
  • 11 Joseph J. Rhinoplasty and Facial Plastic Surgery: With a Supplement on Mammaplasty and Other Operations in the Field of Plastic Surgery of the Body: An Atlas and Textbook. Phoenix: Columella Press; 1987: 249-276
    Google Scholar
  • 12 Nelaton C, Ombredanne L. La Rhinoplastie. Paris: Steinheil; 1904: 96-120
    Google Scholar
  • 13 Gillies H, Millard DR. The Principles and Art of Plastic Surgery. Boston: Little, Brown; 1957: 152-171
    Google Scholar
  • 14 Xu Y, You J, Wang H, Fan F. Repairing nasal defect and lower eyelid defect with a tube flap. J Craniofac Surg 2020; 31 (08) 2376-2377
    CrossrefPubMedGoogle Scholar
  • 15 de Roche R, Hammer B, Rometsch M, Lüscher NJ. Immobilisation for a Tagliacozzi nasal reconstruction using an ASIF external craniofacial fixation apparatus. Eur J Plast Surg 1993; 16: 310-312
    CrossrefGoogle Scholar