Advancement perforator cheek flap for aesthetic one-stage reconstruction of postoncological extended split-thickness defects of the nasal sidewall.

Aesthetic reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. The unique character of this subunit and the complex relationships with a number of different facial or nasal subunits make the excision of large tumors difficult to manage. Numerous techniques are described in the literature, but a primary reconstruction with a final good result is not often possible. The authors develop an advancement cheek flap for an aesthetic one-stage reconstruction of postoncological extended nasal sidewall defects. Between January 2009 and July 2012, 16 patients (mean age, 63.3 yr) underwent excision of skin tumors of nasal sidewall and immediate reconstruction with an advancement cheek flap nourished by perforators from the transverse facial branch of the superficial temporal artery. The tumors were excised with 0.4-0.6 cm lateral margins and defects size ranged from 2.6 × 2.6 cm to 3.5 × 5 cm. Oncological radicality was obtained in all cases. The aesthetic results were excellent in all patients. No scar revision was needed. The authors' advancement cheek flap can be considered the first choice for reconstruction of split-thickness defect of nasal sidewall larger than 2.5 cm because it reestablishes in one stage the nasal contour detail.

Angio computed tomography preoperative evaluation for anterolateral thigh flap harvesting.

The vascular anatomy of the anterolateral thigh flap (ALTF) has many possible variations, and none of the currently used mapping techniques (eg, Echo Color Doppler) gives a thorough knowledge of all details. Among the last generation of angiographic diagnostic techniques, multi detector computed tomography, popularly known as Angio CT, has emerged as an outstanding noninvasive operator independent option, and has been described for deep inferior epigastric perforator and pedicled transverse rectus abdominis muscle planning. This study was conducted to evaluate its usefulness prior to ALTF harvesting.Nine consecutive patients were considered for oral or lower extremity reconstruction with the ALTF. After written informed consent was obtained from all patients, a preoperative Angio-CT study was performed for surgical planning. Accurate identification of septocutaneous or musculocutaneous perforator vessels was achieved and their location, course, and anatomic variations were reported and influenced surgery. Angio CT allows a complete vascular study of the donor area of the ALTF and evaluation of the best perforator vessels before surgery allows surgeons to get an ideal planning of the flap. This imaging method is currently proposed to every patient undergoing ALT flap reconstruction.