Nasal Reconstruction Using Free Flaps: Properties of Various Donor Sites

Nasal reconstructions are mostly performed with a forehead flap or nasolabial flaps. However, total nasal reconstruction can be challenging, especially when inner lining and cartilageous support has to be provided after Moh's surgery for peretrating BCCs.

In a series of 19 nasal reconstructions using free flaps, 4 BBCs, 7 SCCs, 1 cocaine nose necrosis, and 1 vascular occlusion were the indications for free flap reconstruction. Seven lateral forearm flaps, 3 groin flaps, 2 lateral arm flaps, and 1 dorsalis pedis flap where used. In 1 case, a double free flap was used. Bony reconstruction was performed with 3 iliac crest bone grafts, 3 cases with rib cartilage, and one with a piece of humerus. In 6 cases, the free flap was used for inner lining, in 7 cases for cover, and in 5 cases inner lining was provided by a split–thickness skin graft on the subcutaneous fat of the free flap. In 6 cases, the nostril was reconstructed with an ear helix free flap based on the superficial temporal vessels.

All flaps healed uneventfully after anastomosis on the facial vessels. Secondary defatting and correction of the nostrils was required in 8 cases, except in the free ear cartilage flap cases.

Free flaps for nasal reconstructions offer many advantages. The large amount of tissue available is a major advantage. A very limited retraction during the postoperative phase is very well appreciated. Bony reconstruction by iliac crest is acceptable when no columella reconstruction is performed. For columella reconstruction, the authors prefer rib cartilage which is also used for the nasal dorsum.

The advantages of composite free tissue transfer in complex or total nasal reconstruction for various etiologies were evaluated in this paper and an algoritm was provided.