title: Total nose reconstruction using superselective embolisation and a forehead flap: overlooked in recurrent massive vascular malformations of the nose.
abstract: OBJECTIVE
  Massive vascular malformations of the nose cause serious cosmetic, functional and psychological problems. Generally, no single treatment modality to date has provided satisfactory results. Therefore, multidisciplinary treatment approaches are being standardised. In spite of standard multidisciplinary treatments, especially postoperative outcomes in massive nasal vascular malformation cases are often aesthetically and functionally unsatisfactory due to the unique characteristics of the nose. While several studies report on the management of facial vascular malformations using local and distant flaps, none is specific to the nasal region.
  
  
  METHODS
  The present article describes the treatment of four patients with recurrent massive nasal vascular malformation (which invades more than two-thirds of the nose) using a combined-procedure approach involving preoperative superselective embolisation, extensive (en bloc) malformation resection and nasal reconstruction using a paramedian forehead flap. Patients were followed up for a mean of 19 months. Preoperative assessments included MR angiography, selective angiography and physical examination, including Doppler sonography. Preoperative superselective embolisation was then performed by a radiologist. On post-embolisation day 2, patients underwent en bloc resection and total nasal reconstruction with paramedian forehead flap hitherto overlooked in the treatment of nasal vascular malformation.
  
  
  RESULTS
  Satisfactory results were achieved in all four patients. Three patients suffered a high-flow malformation and one suffered a low-flow malformation. As confirmed by the radiologist, no recurrences were noted. Colour matching and nasal contouring were satisfactory in all cases. There were no major complications such as serious infection, recurrent ulceration, postoperative bleeding or flap failure. All patients responded positively.
  
  
  CONCLUSIONS
  The present novel treatment of massive vascular malformations of the nose using selective embolisation, en bloc resection and a paramedian forehead flap was successful. The findings indicate that this treatment of massive nasal vascular malformations leads to successful functional and aesthetic outcomes. The patients were followed up for an average of 2 years and ongoing follow-up is scheduled.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, Republic of Korea. pschoi@amc.seoul.kr
authors.forename: Jong Woo
authors.initials: JW
authors.lastname: Choi
authors.forename: Joon Pio
authors.initials: JP
authors.lastname: Hong
authors.forename: Mu young
authors.initials: My
authors.lastname: Lee
authors.forename: Dea Chul
authors.initials: DC
authors.lastname: Suh