Application of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose.@*METHODS@#The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm.@*RESULTS@#One patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any "cat ear" malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction.@*CONCLUSION@#The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.

Application of nasolabial subcutaneous pedicled flap in repairing skin defect after resection of nasolabial mass / 中华医学美学美容杂志

Objective:To investigate the method and application experience of nasolabial subcutaneous pedicled flap in the repair of skin defect after resection of nasolabial mass.Methods:From December 2016 to December 2020, a total of 58 patients (43 cases of nevus, 12 cases of seborrheic keratosis and 3 cases of keratinacanthoma) were admitted to the Facial Neck Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences, including 24 males and 34 females. They ranged from 17 to 55 years old, with an average age of 33 years. The minimum facial tumor area was 0.8 cm×0.8 cmand the maximum was 2.2 cm×2.0 cm. A local skin flap with a subcutaneous pedicle was designed preoperatively in the nasolabial groove area, and the subcutaneous pedicle was transferred to the defect area through subcutaneous tunnel or by disconnecting the surrounding tissue. The tumor was removed and the skin defect was closed at one stage. Postoperative complications were summarized and patient＇s satisfaction was investigated.Results:Follow-up period ranged from 6 to 48 months. All the 58 patients had primary healing of the transfer incisions, and all the flaps survived. The blood supply of the flaps was good, and the scar of the operative area was smooth. After resection of peri-lip mass, there was 1 case with obvious scar in the donor area of nasolabial groove, and the overall satisfaction rate was 98.3%.Conclusions:The application of nasolabial subcutaneous pedicled skin flap to repair the skin defect after resection of nasolabial tumor has the advantages of preventing the pulling deformation of the organ, it can be completed in one stage and repair the facial skin defect from a distant position. In addition, the thickness and color of the skin flap are similar to the defect site, and the scar of the donor site is not obvious, and so the appearance and function of the surgery can be satisfied.

Nasolabial flap reconstruction for orofacial defects: A case series

Objective@#To describe our clinical experience with, and functional outcomes of the nasolabial flap for reconstruction of orofacial defects. @*Methods@#Design: Retrospective Case Series. Setting: Tertiary National University Hospital. Participants: Records of 11 patients on whom a nasolabial flap was performed for reconstruction of head and neck defects between January 2013 and December 2018 were analyzed.@*Results@#All patients underwent wide excision with or without frozen section, with or without neck dissection, and nasolabial flap closure was performed by a single surgeon. There were no major complications. In two cases, the nasolabial flap was used as an adjunct for Abbé and deltopectoral flap reconstruction. One had poor oral competence due to the bulk of the deltopectoral flap. Acceptable aesthetics and functional outcomes were achieved. @*Conclusion@#The nasolabial flap is a viable alternative for reconstruction of orofacial defects following head and neck surgeries. Additional cases can help validate our initial experience

Reconstrucción nasal compleja con colgajo frontal y nasolabial / Complex Nasal Reconstruction with Frontal and Nasolabial Flap

RESUMEN Introducción: La reconstrucción nasal con colgajo frontal es frecuente en pacientes de edad avanzada, por lo general de causa oncológica. Con frecuencia se requieren otras técnicas complementarias, cuando los defectos comprometen varias subunidades nasales. Por lo que, reconstruir la nariz en pacientes jóvenes constituye siempre un gran desafío al cirujano plástico, por su repercusión social y la baja autoestima que afecta a estos pacientes. Objetivo: Mostrar las técnicas quirúrgicas empleadas en la reconstrucción nasal de un caso complejo, en el Instituto Nacional de Oncología y Radiobiología de Cuba. Caso clínico: Paciente masculino de 25 años de edad, con antecedentes de salud hasta sufrir un accidente por caída de una bicicleta, que ocasionó la amputación de la punta nasal y parte del ala nasal izquierda, con daño en los cartílagos alares. Conclusiones: La reconstrucción nasal con colgajo frontal y colgajo nasogeniano doblado sobre sí mismo, constituyen una adecuada herramienta quirúrgica del cirujano plástico para reconstruir defectos oncológicos y traumáticos(AU)

ABSTRACT Introduction: Nasal reconstruction with frontal flap is frequent in elderly patients, usually for oncological cause. Other complementary techniques are often required when the defects involve several nasal subunits. Therefore, nose reconstruction in young patients is always a great challenge for the plastic surgeon, due to its social repercussions and the low self-esteem affecting these patients. Objective: To show the surgical techniques used in the nasal reconstruction of a complex case, at the National Institute of Oncology and Radiobiology of Cuba. Clinical case: 25-year-old male patient, with a medical history until he suffered an accident due to a fall off a bicycle, which provoked the amputation of the nasal tip and part of the left nasal wing, with damage to the ala cartilages. Conclusions: Nasal reconstruction with frontal flap and nasolabial flap folded on itself constitute an adequate surgical tool for the plastic surgeon to reconstruct oncological and traumatic defects(AU)

Reconstruction of large nasal alar squamous cell carcinoma defect using a superiorly - Based nasolabial flap

@#The nasal skin is the most common site of malignancy in the face accounting for as much as 25.5 percent by virtue of its location and propensity for direct exposure to ultraviolet radiation from the sun.1-3 Among the various cutaneous malignancies, basal cell carcinoma is the most ommon, but other types of cancer such as squamous cell carcinoma, cutaneous malignant melanoma, and basosquamous carcinoma are also common.4 Following surgical resection of a malignant lesion, the defect calls for a reconstructive option that will restore aesthetics and function. We present a squamous cell carcinoma of the nasal alar skin which underwent excision and reconstruction of the defect using a superiorly - based nasolabial flap. CASE REPORT A 66-year-old man consulted at the outpatient clinic due to a nasal alar mass on the right. The mass started one year prior to consult as a pimple-like lesion on the right nasal ala. There was no history of manipulation or trauma to the aforementioned area. He consulted at a local hospital where he was given unrecalled antibiotics that did not cure the lesion. Instead, he noticed that it gradually enlarged, and a deep ulceration developed within the mass. This prompted consult at our outpatient clinic where a 3 x 2 cm ulcerating mass with crusting and necrotic areas was noted on his right nasal ala. (Figure 1) Anterior rhinoscopy showed an intact mucosa in the right nostril with no gross evidence of tumor involvement. There were no enlarged cervical lymph nodes palpated in the neck. A wedge biopsy revealed a well-differentiated squamous cell carcinoma. He claimed that he had no family history of cutaneous malignancy. However, he had a 20 pack-year history of smoking and was a heavy alcoholic beverage drinker. He previously worked as an electrician and denied chronic exposure to sunlight. He consequently underwent excision of the right nasal alar mass with 5-mm margin. (Figure 2A, B) A histologic evaluation of the margins revealed that the borders and tumor base were negative for malignancy. The alar cartilage was not involved by tumor. Reconstruction of the defect was done using a superiorly - based nasolabial flap on the right. (Figure 3A, B, C) Two weeks postoperatively, the patient came in for follow-up with a healed, aesthetically - pleasing, and well-coaptated wound. (Figure 4) He remains free of any evidence of recurrence after 1 year.

Reconstrucción de defectos totales del ala nasal en pacientes oncológicos / Nasal Ala Reconstruction for Total Defects in Cancer Patients

Introducción: El ala nasal es un área de frecuente incidencia de tumores malignos. La exéresis de estos, deja graves secuelas con repercusión negativa en el paciente. Objetivo: Caracterizar la reconstrucción de defectos totales del ala nasal en pacientes oncológicos. Método: Se realizó un estudio descriptivo, observacional, longitudinal y prospectivo en el Instituto Nacional de Oncología y Radiobiología desde abril de 2014 hasta abril de 2017. La muestra quedó conformada por 32 pacientes que cumplieron los criterios de selección. Resultados: Los pacientes del sexo masculino representaron la mayoría en el estudio. El carcinoma basal fue el diagnóstico histológico más frecuente. La resección de tumores primarios que resultaron en defectos aislados del ala nasal fueron el principal motivo de reconstrucción. El mayor porcentaje de los casos se reconstruyó de forma inmediata. El colgajo frontal fue la técnica más empleada, el cual presentó los mejores resultados estéticos y funcionales. El injerto compuesto de piel presentó el mayor índice de complicaciones. Conclusiones: Con el colgajo frontal doblado sobre sí mismo sin injerto de cartílago, se lograron los mejores resultados estéticos y funcionales(AU)

Introduction: Ala nasi is an area of frequent incidence of malignant tumors, whose exeresis leaves serious sequels with negative impact on the patient. Objective: To characterize nasal ala reconstruction for total defects in cancer patients. Method: A descriptive, observational, longitudinal and prospective study was carried out at National Institute of Oncology and Radiobiology, from April 2014 to April 2017. The sample consisted of 32 patients who met the selection criteria. Results: The study majority was represented by male patients. Basal carcinoma was the most frequent histological diagnosis. Resection of primary tumors that resulted in isolated defects of the nasal ala were the main reason for reconstruction. The highest percentage of cases were reconstructed immediately. The forehead flap was the most used technique, and presented the best aesthetic and functional results. The composite skin graft presented the highest rate of complications. Conclusions: With the forehead flap folded on itself and without cartilage graft, the best aesthetic and functional results were achieved(AU)

Versatility of nasolabial flaps for the management of severe trismus in oral submucous fibrosis.

Background: Oral submucous fibrosis (OSMF) is a chronic insidious disease affecting any part of the oral cavity and sometimes the pharynx. It is a collagen-related disorder predominantly associated with tobacco/areca nut chewing habit and characterized by progressive hyalinization of the submucosa. Prevalence of OSMF is 2.01%, and malignant transformation rate of 2.3%-7.6% has been reported in the literature. Measures such as forcing the mouth open and cutting the fibrotic bands have resulted in more fibrosis and disability. Aim: Various surgical treatment modalities have been advocated in the surgical management of OSMF with variable results. This retrospective study evaluates the efficacy of nasolabial flap in the surgical treatment of OSMF. Materials and Methods: Retrospective analysis of 42 patients who underwent surgical management of OSMF with mouth opening <20 mm by nasolabial flap at authors center from 2000 to 2015. Only the cases diagnosed as advanced OSMF based on long-standing positive history of habits (chewing tobacco, betel nut, etc.), clinical and histopathological examination. OSMF due to other causes such as nutritional deficiency, immunological diseases, and systemic illness with medically compromised patients were excluded from the study. Inferiorly based nasolabial flaps were raised in the supramuscular plane and transferred intraorally through a transbuccal tunnel. Results: The study groups consist of 42 cases of clinical and histopathologically proven cases of OSMF treated by nasolabial flap. Out of 42 cases, 39 (92.85%) were males and 3 (7.15%) were females which showed a male predominance and the ratio was 13:1. The mean (standard deviation [SD]) preoperative mouth opening was 14.60 mm (3.06). After release of fibrotic bands, a mean forced intraoperative mouth opening of 36.27 (2.11) mm was achieved. The mean (SD) postoperative mouth opening was 33.05 mm (2.40) at the end of 2-year follow-up. The mean (SD) increase in mouth opening after surgical management at the end of 2-year follow-up is 18.46 mm (1.89). Sixteen out of 42 patients' histopathological report turned out to be dysplastic. The mean (SD) follow-up was 2.79 years (1.08). There was no incidence of infection in the transferred flap and the recipient site in all cases except one case with malignant transformation. All flaps healed without evidence of infection, dehiscence, or necrosis. Results were assessed by comparing the pre- and post-operative maximum mouth opening. Conclusion: The nasolabial flap is a versatile flap, which can be successfully used in the reconstruction of defects created after the release of fibrotic bands in OSMF. The versatility of the nasolabial flap has been attributed to its reliable vascularity derived from numerous vessels in the vicinity. Major advantage is the ease of elevation, proximity to the defect, suitable size for coverage of defect, minimal swallowing and speech difficulties, and a relatively cosmetic result as scar is in natural crease. All the cases treated for OSMF using bilateral nasolabial flaps showed adequate mouth opening at 2-year follow-up postoperatively, recommending its use.

Reconstrução parcial de nariz baseada em retalho nasogeniano após ressecção de carcinoma espinocelular envolvendo septo nasal, columela e lábio superior / Partial reconstruction of a nose based on a nasolabial flap after the resection of a squamous cell carcinoma involving the nasal septum, columella, and upper lip

INTRODUÇÃO: Reconstruções de defeitos complexos na face constituem um desafio para os cirurgiões. Após ressecção da lesão, o reparo nasal é difícil, já que possui uma variedade de tecidos e área local doadora reduzida para reconstrução. Já as lesões de lábio possuem como principal dificuldade a restauração da função, priorizando a integridade da estrutura esfincteriana, a continência oral, a abertura bucal e a sensibilidade. Entre as alternativas para reconstrução dessas áreas, podemos optar por retalhos locais, entre os quais o nasogeniano. OBJETIVO: Analisar desfechos de reconstrução nasal e de lábio superior em dois tempos cirúrgicos, utilizando retalho nasogeniano, após defeito complexo causado por ressecção de carcinoma espinocelular (CEC). RELATO DO CASO: Paciente do gênero feminino, 56 anos, apresentou CEC de progressão avançada em região nasal da columela, terço anterior do septo e parte do lábio superior. A paciente foi submetida à reconstrução com retalho nasogeniano e, em segundo momento cirúrgico, ao enxerto de cartilagem costal para reconstrução de columela. Apresenta evolução com boa integração e viabilidade dos enxertos e retalhos. O resultado estético foi satisfatório. CONCLUSÃO: A utilização de retalho nasogeniano como opção terapêutica para a reconstrução parcial de nariz e de lábio superior apresentou desfechos funcionais/estéticos favoráveis. Além disso, a segmentação do procedimento cirúrgico traz segurança na utilização dos retalhos locais, principalmente em indivíduos de difícil cicatrização.

INTRODUCTION: Reconstruction of complex facial defects is a challenge for surgeons. After the excision of a lesion, nasal reconstruction is challenging because of the variety of tissues involved and the reduced local donor area for reconstruction. On the other hand, a major difficulty in the reconstruction of lip lesions is restoration of function, with the priority being the maintenance of the integrity of the sphincter structure, oral continence, mouth opening, and sensitivity. Among the alternatives for the reconstruction of these areas are local flaps, including the nasolabial flap. AIM: To analyze the outcome of nasal and upper lip reconstruction performed in two surgical stages, by using a nasolabial flap for complex defects resulting from the resection of squamous cell carcinoma (SCC). CASE REPORT: A 56-year-old female patient presented with advanced SCC in the nasal region of the columella, anterior third of the septum, and part of the upper lip. She underwent reconstruction with a nasolabial flap and, in a second surgical procedure, with a costal cartilage graft for the reconstruction of the columella. The procedures resulted in good integration and viability of grafts and flaps. The aesthetic result was satisfactory. CONCLUSION: The use of a nasolabial flap as a therapeutic option for the partial reconstruction of the nose and upper lip produces favorable functional and aesthetic outcomes. In addition, the division of the surgical procedure into stages provides safety in the use of local flaps, particularly in patients with poor healing.

Application of auricular composite tissue flap graft in reconstruction of nasal alar defect / 局解手术学杂志

Objective To evaluate the clinical efficacy of the application of auricular composite tissue flap in treatment of nasal alar de-fect. Methods 43 cases of nasal defects patients were admitted to our hospital from January 2008 to March 2013, 23 cases of them were treated with auricular composite tissue flap transplantation, and the other 20 cases were given nasolabial sulcus flap transfer operation. All patients were followed-up for 6 to 12 months, and the rate of secondary surgery, proliferation of scar, and flap survival of the two groups were compared. Results Treatment of auricular composite tissue flap transplantation has more advantages in terms of the rate of secondary surgery, proliferation of scar, and flap survival, and the difference is of statistical significance (P<0. 05). And there is no obvious differ-ence in satisfaction degree of cosmetic outcomes. Conclusion Auricular composite tissue flap surgery has the advantages of simple opera-tion, good appearance and good efficacy.

Use of Nasolabial Flap in the Management of Oral Submucous Fibrosis – A Clinical Study.

Oral submucous fibrosis is a chronic debilitating disease associated with restricted mouth opening and poor oral hygiene. The treatment aims at good release of fibrosis and to provide long term results in terms of mouth opening. Various local grafts have been used to cover the buccal mucosal defects after the fibrotic bands are released in oral submucous fibrosis. Successful use of inferiorly based nasolabial flaps in the management of oral submucous fibrosis is projected. A total of 10 histologically proven cases of oral submucous fibrosis having a mouth opening of less than 20 mm were surgically treated .The procedure involved (1) bilateral release of fibrotic bands (2) measurement of intra-operative interincisal distance (greater than 35 mm achieved in all patients after release of bands) (3) covering the defects with inferiorly based nasolabial flap. All patients had post-operative physiotherapy, and were followed up regularly for one year. All flaps healed without evidence of infection, dehiscence, or necrosis. Results were assessed by comparing the pre-operative & pos-toperative maximum mouth opening. The inferiorly based nasolabial “islanded” flaps provide reliable coverage of defects of the buccal mucosa and improves mouth opening.

Retalho nasolabial versátil em cirurgia de reconstrução de nariz / Versatile nasolabial flap in reconstrutive nose surgery

A reconstrução nasal é a mais antiga das operações plásticas. Com a melhoria das ações preventivas de saúde, as reconstruções totais estão cada vez mais raras, dando lugar às reconstruções parciais, que podem ser realizadas por meio de procedimentos simples e criativos. A versatilidade e a utilidade do retalho nasolabial são bem conhecidas na reconstrução do nariz, pois a vasta vascularização e as poucas limitações e desvantagens o tornam adequado para cobrir pequenos e médios defeitos do nariz. Este trabalho tem por objetivo demonstrar, através do relato de um caso, a simplicidade e eficácia da reconstrução da asa e porção lateral do dorso do nariz, restabelecendo harmonia estética na face, pela técnica do retalho nasolabial

Nasal reconstruction is the oldest among the plastic surgeries. With the improvement of preventive health care, total reconstructions are increasingly rare, but partial reconstructions can be accomplished through simple and creative procedures. The versatility and utility of the nasolabial flap are well known in the reconstruction of the nose, as its vast vascularization and the few limitations and disadvantages make it suitable to cover small and medium defects of the nose. This paper aims to demonstrate, through the report of a case, the simplicity and effectiveness of reconstruction of the wing and lateral portion of the back of the nose, restoring aesthetic harmony in the face, by the technique of the nasolabial flap

A Clinical Case of Unilateral Maxillary Defect Reconstruction Using Nasolabial Flap

Usage of nasolabial skin flaps for the reconstruction of various intraoral defects

Variations of the Transposition Flap for Facial Reconstruction after Mohs Micrographic Surgery of the Basal Cell Carcinoma

BACKGROUND: The transposition flap is one of the most useful methods of facial reconstruction after Mohs micrographic surgery of the basal cell carcinoma, but occasionally some variations are needed. OBJECTIVE: We present our experience with several variations of the transposition flap to overcome the disadvantages of classic rhomboid flaps. METHODS: We performed the Webster 30-degree angle flap on the lower eyelid, the double 30-degree angle flap on the temple area and the nasolabial flap on the ala nasi. RESULTS: These variations of the transposition flap gave no complications such as ectropion, tissue distortion, protrusion, or trapdoor deformity. CONCLUSION: The variations of the transposition flap in our cases might be of help in selecting the ideal method in facial reconstruction.