Turnover Flap and Composite Graft

(Lexer 1931, modified by Kastenbauer 1977)

A bipedicled turnover flap is used for intranasal lining (Fig. 5.39a, b), similar to the technique just described. Then a two-layer composite graft is used to reconstruct the alar rim. The skin of the composite

Composite Skin Graft
Fig. 5.36 Modification of the anteriorly based alar rotation. a An incision is made around the ala, and two adjacent flaps are outlined. b The ala is brought down to the desired position, and the flaps are transposed. c Appearance after the reconstruction.
Composite Graft Pictures

Fig. 5.37 Reconstruction of the ala using a turnover flap and a transposition flap from the na-solabial fold.

a The turnover flap for lining the defect is outlined, excising a small triangular skin flap as needed. b Lining of the defect is completed, and the transposition flap is raised. c Appearance after the reconstruction. (Additional inset of the pedicle may be necessary.)

Fig. 5.37 Reconstruction of the ala using a turnover flap and a transposition flap from the na-solabial fold.

a The turnover flap for lining the defect is outlined, excising a small triangular skin flap as needed. b Lining of the defect is completed, and the transposition flap is raised. c Appearance after the reconstruction. (Additional inset of the pedicle may be necessary.)

Raising The Alar Rim

Fig. 5.38 Lowering the alar rim with a full-thickness bipedicle flap and closing the defect with a full-thickness auricular composite graft (see Fig. 2.23). a A full-thickness incision is made around the ala, the rim is lowered, and a full-thickness composite graft is harvested from the auricle (making the skin component slightly larger than the cartilage component). The auricular defect is covered with a retroauricular island flap (see Fig. 10.1). b The defects are closed. The retroauricular surface of the composite graft faces outward.

Full Thickness Skin Graft

Fig. 5.39 Turnover flap and composite graft (see Fig. 5.37). a An incision is made around the alar rim. b The flap is hinged over, its edges are freshened, and the turnover flap is sutured in place. A two-layer composite graft is harvested with a slightly larger skin island, and its distal edge is folded over to create an alar rim. c The composite graft is inset into the defect.

Fig. 5.39 Turnover flap and composite graft (see Fig. 5.37). a An incision is made around the alar rim. b The flap is hinged over, its edges are freshened, and the turnover flap is sutured in place. A two-layer composite graft is harvested with a slightly larger skin island, and its distal edge is folded over to create an alar rim. c The composite graft is inset into the defect.

Alar And Prevertebra Facial Layer

Fig. 5.40 Reconstruction of the alar rim with an inferiorly based transposition flap.

a Lining is reconstructed with a turnover flap. b The ala is reconstructed with an inferiorly based transposition flap (1). c The central defect is repaired with a composite graft (2).

Fig. 5.40 Reconstruction of the alar rim with an inferiorly based transposition flap.

a Lining is reconstructed with a turnover flap. b The ala is reconstructed with an inferiorly based transposition flap (1). c The central defect is repaired with a composite graft (2).

graft is infolded to create a natural-appearing rim (Fig. 5.39c).

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Responses

  • yorda
    Is a turn over flap a pedicle graft?
    3 months ago

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