title: Microvascular repair of heminasal, subtotal, and total nasal defects with a folded radial forearm flap and a full-thickness forehead flap.
abstract: BACKGROUND
  The site, size, and depth of tissue loss, irradiation, or composite injury to adjacent cheek and lip may make local tissues inadequate or unavailable for the repair of major nasal defects.
  
  
  METHODS
  In 13 patients, a single, folded, horizontal radial forearm flap was used to line the vault and columella, with an incontinuity fasciocutaneous extension to resurface the nasal floor, with or without primary dorsal support. Later, excess external forearm skin was turned over to adjust the nostril margin and alar base positions. Delayed primary cartilage grafts completed subunit support. A three-stage full-thickness forehead flap provided covering skin. Three-dimensional contouring of the midlayer framework was performed over the entire nasal surface, during an intermediate operation, before pedicle division.
  
  
  RESULTS
  Good to excellent aesthetic and functional results were obtained in total and subtotal defects in five operations over 8 months, including a late revision. Partial necrosis of the folded columellar lining (n = 2) and dehiscence of unilateral alar lining (n = 1) were salvaged at forehead flap transfer by hinging over excess external forearm skin (n = 2) or by folding the extension of the forehead flap for columellar lining (n = 1). Indolent cartilage infection necessitated débridement (n = 4) and partial support replacement (n = 3). No free flaps were lost or required to salvage a complication.
  
  
  CONCLUSIONS
  The approach is reliable, efficient, and applicable to varied defects and has the ability to correct design errors and complications before pedicle division. An unscarred lining sleeve, defined three-dimensional contour, and thin conforming skin cover are restored.
authors.affiliation: Tucson, Ariz.; and Orange, Calif. From St. Joseph's Hospital.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Menick
authors.forename: Arthur
authors.initials: A
authors.lastname: Salibian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002356:Cartilage / Q000637:transplantation; D002648:Child; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009666:Nose / Q000293:injuries*; D009669:Nose Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013544:Sweat Gland Neoplasms / Q000532:radiotherapy / Q000601:surgery; D015626:Tissue Expansion; D055815:Young Adult