A Defect Involving the Medial Cheek and Full-Thickness Nose

Nasal Lining Repair: A Comprehensive Literature Review

“…These hinge flaps are apt for deep defects of the dorsum, nasal sidewall, and ala. 16 For hinge flaps from the cutaneous nasal sidewall, a template can be made to approximate the size of the defect using a skin marker and nonadherent pad, then outlined superior to the defect in a vertically flipped fashion. 17 When hinge flaps are incised, it is critical to ensure a robust subcutaneous tissue and muscular pedicle. It is also beneficial to ensure that the flap's vertical height is slightly greater than the vertical height of the mucosal defect to account for wound contracture.…”

“…For larger defects, a similar approach can be executed from the larger reservoir of the medial cheek. 17 The surrounding mucosal epithelium is secured to the cutaneous surface of the hinge flap [Figure 1]. The subcutaneous aspect is then delicately trimmed to an appropriate thickness to match the contralateral nose to ensure symmetry, while being mindful not to over trim and compromise the pedicle.…”

“…16,23 Two options exist for the "turned in" or "folded over" portion of the flap for full-thickness defects: the proximal or distal portion of the flap may be use as the internal nasal lining depending on the position relative to the alar base, and per the surgeon's preference (See Supplemental Digital Content 4 and 5, Figures S4 and S5, http://links.lww.com/DSS/A2). 11,17,22,24 Some surgeons prefer that the proximal portion of the nasolabial fold be used to recreate the lining as then the distal aspect of the flap can be contoured to the shape of the cutaneous defect more aptly. 25 In this design, a more superior pedicle that folds over is used.…”

“…For larger defects, a similar approach can be executed from the larger reservoir of the medial cheek. 17…”

“…16,23 Two options exist for the “turned in” or “folded over” portion of the flap for full-thickness defects: the proximal or distal portion of the flap may be use as the internal nasal lining depending on the position relative to the alar base, and per the surgeon's preference (See Supplemental Digital Content 4 and 5 , Figures S4 and S5, http://links.lww.com/DSS/A2). 11,17,22,24…”