Partial and Total Nasal Reconstruction

Median or oblique forehead flaps (see Figs. 5.15,5.16, 5.49, and 5.53) can be effectively used for nasal reconstruction, depending on the size and location of the defect. In other cases turnover flaps can be used in conjunction with nasolabial flaps (see Figs. 5.11 and 5.40) or bilobed flaps (see Fig. 5.46), or complex flaps may be required. Various flap combinations can be used in the reconstruction of large defects. When a large forehead flap has been transferred (see Figs. 5.16 and 5.49), the upper two-thirds of the donor defect can be closed by an H-advancement of the forehead skin (Fig. 5.49c) or with bilateral rotation flaps (Fig. 5.49d). If the scalp is hair-covered, the superior flap incisions should be placed about 2 cm behind the hairline. The flaps should be securely

Nasolabial Flap Reconstruction

Fig. 5.48 Columellar reconstruction with a full-thickness composite graft from the helix. a Donor site.

b Inset of the composite graft (see Gersuny's technique for resecting a helix tumor, Fig. 10.5).

Superior Lip Reconstruction Scalp BearHelix Plastik TumorComposite Nostril GraftsTotal Nasal Reconstruction

Fig. 5.49 Nasal reconstruction using a large median forehead flap (see Figs. 5.15 and 5.16). a The forehead flap is outlined. The nasal lining can be reconstructed with split-thickness skin, a nasolabial flap (see Fig. 5.42), or a sliding flap (see Fig. 5.44). b Inset of the flap into the defect.

c, d The donor defect can be closed with an H-flap (c) or bilateral rotation flaps (d) (see Figs. 4.2-4.4).

Facial Reconstruction Surgery

Fig. 5.50 Reconstruction of the nose, cheek, and upper lip.

a, b The esthetic unit of the cheek and upper lip is reconstructed with an Esser cheek rotation (left), cheek advancement (right), and modified Grimm lip reconstruction (see Fig. 6.45).

Fig. 5.50 Reconstruction of the nose, cheek, and upper lip.

a, b The esthetic unit of the cheek and upper lip is reconstructed with an Esser cheek rotation (left), cheek advancement (right), and modified Grimm lip reconstruction (see Fig. 6.45).

c Nasal lining is reconstructed with a median forehead flap placed over silicone stents. d, e The external nose is reconstructed with a Converse scalping flap (see Fig. 5.51).

coapted with absorbable subcutaneous sutures. Further details on these flaps are shown in Figure 5.15. Oblique forehead flaps can also be used (see Figs. 5.16 and 6.4).

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