The Versatility of Expanded Applications of the Dorsal Nasal Flap in Nasal Reconstruction

Document Type : Original Article

Authors

1 The Department of Plastic Surgery, Faculty of Medicine, Fayoum University

2 The Department of Plastic Surgery, Faculty of Medicine, Fayoum University Correspondence to:

Abstract

Background: Aesthetic nasal reconstruction always offers
a challenge to the plastic surgeon, especially with large defects
of more than 2cm. The modification of the dorsal nasal flap < br />might offer a superior alternative for the forehead flap.
Objective: In this study, we aimed to assess the outcomes
of the dorsal nasal flap in the reconstruction of large nasal defects
beyond the original indications.
Patients and Methods: We have prospectively studied 12
patients older than 40 years with skin-only nasal defects occupying
the distal 2/3 of the nose, larger than 2cm in size, and/
or located less than 5mm from the alar rim. A modified dorsal
nasal flap was done in all the cases.
Results: The mean age of patients was 59.33±7.01 years.
The mean dimensions of lesions were 25±2.32mm with a mean
distance of 2.57±1.62mm from the alar rim. Regarding Aesthetic
outcomes, patients and surgeons expressed excellent
color match in 91.7% of patients. As for alar retraction, patients
and doctors expressed good to excellent results in 83%
of patients. Additionally, patients and physicians reported
good to excellent nostril shape in 83.3% and 66.6% of patients
respectively. Regarding the flap thickness, patients and doctors
expressed good to excellent results in 91.6% and 75% of patients
respectively.
Conclusion: The dorsal nasal flap seems to be more applicable
than classically reported. Defects up to 29mm in size
and/or defects located 2mm from the alar rim result in acceptable
to excellent aesthetic outcomes when the modified dorsal
nasal flap applied in this work is used. Our modified dorsal
nasal flap resulted in excellent outcomes in 4 cases, accepted
outcomes in 5 cases, and unfavorable outcomes in 3 cases.

Keywords

Main Subjects


Baker S.R.: Anatomic consideration In: Principles of Nasal
Reconstruction. 2nd Edition ed.: Springer, 13-22, 2011.
2- Shaye D.A.: The history of nasal reconstruction. Current
opinion in otolaryngology & head and neck surgery, 29
(4): 259-264, 2021.
3- Park S.S.: Nasal reconstruction in the 21st century a
contemporary review. Clinical and experimental otorhinolaryngology,
1 (1): 1-9, 2008.
4- Austin G.K. and Shockley W.W.: Reconstruction of nasal
defects: Contemporary approaches. Current opinion in
otolaryngology & head and neck surgery, 24 (5): 453-460,
2016.
5- Rieger R.A.: A local flap for repair of the nasal tip. Plastic
and reconstructive surgery, 40 (2): 147-149, 1967.
6- Marchac D. and Toth B.: The axial frontonasal flap revisited.
Plastic and reconstructive surgery, 76 (5): 686-694,
1985.
7- Eren E. and Beden V.: Beyond Rieger’s original indication;
the dorsal nasal flap revisited. Journal of cranio-maxillo-
facial surgery: Official publication of the European
Association for Cranio-Maxillo-Facial Surgery, 42 (5):
412-416, 2014.
8- Redondo P., Bernad I., Moreno E., et al.: Elongated Dorsal
Nasal Flap to Reconstruct Large Defects of the Nose. Dermatologic
surgery: Official publication for American Society
for Dermatologic Surgery, 43 (8): 1036-1041, 2017.
9- Bitgood M.J. and Hybarger C.P.: Expanded applications of
the dorsal nasal flap. Archives of facial plastic surgery, 9
(5): 344-351, 2007.
10- Park S.S.: Reconstruction of Nasal Defects Larger Than
1.5 Centimeters in Diameter, 110 (8): 1241-1250, 2000.
11- Kaya İ., Uslu M. and Apaydın F.: Defect Reconstruction
of the Nose After Surgery for Nonmelanoma Skin Cancer:
Our Clinical Experience. Turkish archives of otorhinolaryngology,
55 (3): 111-118, 2017.
12- Badash I., Shauly O., Lui C.G., Gould D.J. and Patel
K.M.: Nonmelanoma facial skin cancer: A review of diagnostic
strategies, surgical treatment, and reconstructive
techniques. Clinical Medicine Insights: Ear, Nose and
Throat, Jul. 12:1179550619865278, 2019.
13- Gulati A., Grekin R., Neuhaus I., Saylor D., Yu S., Park
A., Seth R. and Knott P.D.: Long-term appearance-related
outcomes of facial reconstruction after skin cancer resection.
Facial Plastic Surgery & Aesthetic Medicine, Aug. 1;
25 (4): 344-50, 2023.
14- Joseph A.W., Truesdale C. and Baker S.R.: Reconstruction
of the Nose. Facial Plastic Surgery Clinics, Feb. 1; 27 (1):
43-54, 2019.
15- Kim M J. and Choi J.W.: Total nasal reconstruction with
a forehead flap: Focusing on the facial aesthetic subunit
principle. Journal of Plastic, Reconstructive & Aesthetic
Surgery, Aug. 1; 74 (8): 1824-31, 2021