title: Total nasal reconstruction: utility of the free radial forearm fascial flap.
abstract: BACKGROUND
  Total nasal defects present daunting challenges to the reconstructive surgeon. The nasal skeleton can be successfully fabricated with bone and cartilage. Reconstruction of the nasal skin with a forehead flap produces an excellent color match for nasal skin. Resurfacing of the internal lining is the most difficult of the 3 layers. Local tissue is often unsatisfactory in amount and/or vascular supply.
  
  
  METHODS
  A patient requiring total nasal reconstruction was prospectively examined. Intraoperative technique was recorded, and postoperative function was determined.
  
  
  RESULTS
  A paramedian forehead flap was used to resurface the external defect. Split calvarium and conchal cartilage were used to reconstruct the nasal skeleton. A fascial flap harvested from the forearm was used to replace the intranasal lining. Turbinate grafts were placed to line the flap. Postoperative breathing was excellent.
  
  
  CONCLUSIONS
  The intranasal portion of a total nasal defect can be successfully reconstructed with a fascial forearm flap. Placement of a turbinate or mucosal graft allows for a thin mucosalized lining with an excellent functional outcome.
authors.affiliation: Section of Otolaryngology, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA. cwinslow@pol.net
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Winslow
authors.forename: Ted A
authors.initials: TA
authors.lastname: Cook
authors.forename: Alan
authors.initials: A
authors.lastname: Burke
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
mesh_terms: D000368:Aged; D005205:Fascia / Q000637:transplantation*; D005542:Forearm / Q000601:surgery*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012225:Rhinoplasty / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps