Reconstruction of Subtotal Nasal Defect with Radial Forearm Free Flap and Forehead Flap: A Case Report

Reconstructive rhinoplasty is one of the unique areas of rhinoplasty, but its concept and technique have not been widely established in Korea compared to cosmetic rhinoplasty. Nasal reconstruction poses a challenging problem when the defect is large and involves all 3 layers of the nose including the septum. We report a patient who underwent nasal reconstruction due to subtotal, full thickness defect of the nose after repeated failed rhinoplasties including use of a nasolabial flap. A staged operation was planned. First, a radial forearm free flap was used to reconstruct the inner layer. After 4 months, the bulk of the forearm tissue was reduced and used as inner lining at the second operation. In the second operation, the framework of the lower 2/3 of the nose was formed of autologous rib cartilage, and the outer skin defect was covered with a forehead flap. Six weeks later, the forehead flap was divided. One year after the last operation, the patient can breathe well, and his nose has better esthetics than before surgery. We believe this is the first report of nasal reconstruction using a radial forearm free flap and a forehead flap to restore a subtotal, full thickness defect of a nose.

Three Cases of Reconstructive Rhinoplasty Using a Local Flap or a Split Calvarial Bone Graft / 대한이비인후과학회지

The nose is located centrally in the face and occupy an important place in the harmonic architecture of the face. Also, it plays important functions such as respiraton, olfaction and phonation. Therefore, reconstructive rhinoplasty is dealt with both cosmetic and functional aspect in mind. We have recently experienced three cases of reconstructive rhinoplasty for seborrheic keratosis of the nose, traumatic nasal defect, and basal cell carcinoma of the nose. Local flap and split calvarial bone graft were used for the reconstruction of the nose.