Total Nasal Reconstruction with the Sickle Flap Farrior 1974

As in other reconstructions following total nasal loss, the forehead skin can be augmented by soft-tissue expansion for 6-8 weeks before the flap is incised (see Fig. 4.5).

Stage I: The skin flap is taken from the median forehead, and its distal end is preshaped to form the alae and columella. As with the Converse scalping flap (Figs. 5.50 and 5.51 ), the flap should not be made too narrow (Fig. 5.52a). It receives its blood supply from branches of the superficial temporal artery. Nasal lining is reconstructed with a thick split-thickness or full-thickness skin graft from the supraclavicular region. We stent the nostril openings with 8-mm silicone tubing (Fig. 5.52b). Incisions can be made over the eyebrow and in the scalp in an attempt to reduce the size of the donor defect in the forehead or close it primarily (see Figs. 4.2, 4.3, and 5.49). As with the

Fig. 5.52 Sickle flap of Farrior (1974).

a The lower portion of the sickle flap is a median forehead flap at least 8 cm wide. It is supplied by a "transport flap" incised in the scalp and based on the superficial temporal artery (the galea remains intact).

Converse flap, the pericranium is left intact and is covered with impregnated gauze or a similar dressing during healing of the reconstructed nose. Stage II: About 3-4 weeks after inset of the new nose, the pedicle is first partially incised on both sides and then divided, and the sickle flap is returned to the scalp.

- Residual defects in the forehead are grafted in the same sitting with retroauricular or postauricular full-thickness skin (see Fig. 5.51d, e). Again, the granulation tissue should reach the level of the surrounding skin.

- If necessary, costal or auricular cartilage can be implanted at this stage for intranasal support.

Stage III: Approximately 6 months later, the flap is defatted and secondary scar revisions are carried out.

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