Complex Nasal Reconstruction

Taghinia, Amir H.; Pribaz, Julian J.

doi:10.1097/01.prs.0000298113.56554.c3

Cited by 54 publications

(48 citation statements)

References 48 publications

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“…A patent nasal airway often depends on the bulk of the reconstruction, particularly of the ala. Local flaps, including the nasal turn-in flap, nasolabial flap, and forehead turn-in flap (hinged flap), may be used for reconstruction of the nasal lining, but these flaps are also bulky and provide only limited amounts of reconstructive tissue. 1,7 Walton et al 5 and Moore et al 13 have extensively demonstrated the use of free flaps for total nasal reconstruction. The most commonly used flap in these series is the radial forearm free flap.…”

Section: Commentmentioning

confidence: 99%

“…To accomplish this, the reconstructive surgeon may require the combined use of locoregional and distant flaps. 2,7 Methods of nasal reconstruction are thought to have developed in India more than 2600 years ago. This development is likely linked to the practice of rhinokopia (nasal amputation) as a form of punishment.…”

Section: Commentmentioning

confidence: 99%

“…Functionally, the keratinized surface of the grafts can cause nasal dryness and crusting within the nasal cavity. 7 Endogenous nasal mucosal grafts provide an ideal reconstructive source for similar tissue; often in total nasal reconstruction, however, enough tissue for full reconstruction of the nasal lining is lacking. Intraoral mucosal flaps, particularly the facial artery musculomucosal flap, may be used, but these flaps are typically thick and require extensive subsequent thinning procedures.…”

Section: Commentmentioning

confidence: 99%

“…In addition, pliability of the flap is limited secondary to its thickness. 7 Fascial flaps have several advantages to fasciocutaneous flaps for nasal lining reconstruction. Fascial flaps are thin and pliable and do not bear keratinized squamous epithelium.…”

Section: Commentmentioning

confidence: 99%

“…Although this flap is one of the more pliable and thin flaps used in free tissue transfer, multiple debulking procedures are required until an adequate nasal airway may be achieved. [5][6][7] Overall use of the anterolateral thigh (ALT) free flap for head and neck reconstruction has increased greatly during the past decade, and many surgeons now use this flap preferentially for cutaneous and mucosal replacement. Cutaneous perforators within this flap pass through and vascularize the fascia lata, thus allowing for development of a free vascularized fascia flap.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Free Anterolateral Thigh Fascia Lata Flap for Complex Nasal Lining Defects

Seth¹,

Revenaugh²,

Scharpf³

et al. 2013

JAMA Facial Plast Surg

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Free Anterolateral Thigh Fascia Lata Flap for Complex Nasal Lining Defects

Seth¹,

Revenaugh²,

Scharpf³

et al. 2013

JAMA Facial Plast Surg

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Anterolateral Thigh Adipofascial Flap in Mucosal Reconstruction

Revenaugh

Haffey

Seth

et al. 2014

JAMA Facial Plast Surg

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arge mucosal defects can be challenging to the reconstructive surgeon. Throughout the oral and nasal cavities, the mucosa is a thin, compliant, and functional membrane providing properties necessary for mastication, food bolus control, speech, and nasal airway patency. The unique properties and limited supply of mucosa are fundamental difficulties in reconstruction of large defects. With larger mucosal defects, complicated closures, or irradiated fields, microvascular-free tissue transfer often is indicated to ensure vascularized coverage.The anterolateral thigh (ALT) flap has recently become a "workhorse" of head and neck reconstruction. Since its description as a musculocutaneous free flap by Song et al in 1984, 1 the ALT has been adopted for a number of indications. The flap is reliably vascularized by several perforators off of the descending or transverse branch of the lateral circumflex femoral artery. Although predominantly musculocutaneous, all of these perforators traverse the fascia overlying the vastus lateralis (fascia lata) as well as the subcutaneous fat before terminating in the subdermal plexus. 2 Consequently, the ALT flap can be harvested without skin and without inclusion of muscle surrounding the perforators, resulting in a thin, pliable, ALT adipofascial free flap (ALTAF).To date, there have been few case series and case reports 3-6 describing the use of ALTAF in the head and neck. We now have several years of experience with this flap for mucosal reconstruction and have used it for oral cavity reconstruction, including palate, gingival, tongue, and buccal mucosa reconstruction. We also have used the flap in nasal lining reconstruction. 7 In this article, we review the straightforward harvest of the ALTAF and highlight our experience with the versatile indications and some contraindications for use of this flap. MethodsAll patients undergoing free tissue transfer at the Cleveland Clinic, Cleveland, Ohio, between January 1, 2009, and June 30, 2013, were reviewed, and those undergoing ALTAF for muco-IMPORTANCE This study describes a reliable technique for mucosal reconstruction of large defects using components of a common free flap technique.OBJECTIVE To review the harvest technique and the varied scenarios in which the anterolateral thigh adipofascial flap (ALTAF) can be used for mucosal restoration in oral cavity and nasal reconstruction. DESIGN, SETTING, AND PARTICIPANTSA retrospective review of the medical records of 51 consecutive patients was conducted. The patients had undergone ALTAF head and neck reconstruction between January 2009 and June 2013. Each case was reviewed, and flap survival and goal-oriented results were evaluated.RESULTS Thirty patients met the inclusion criteria and were included in the analysis. The mean patient age was 60.6 years. Reconstruction sites included the tongue, palate, gingiva, floor of the mouth, and nasal mucosa. All mucosal reconstructions maintained function and form of replaced and preserved tissues. One patient (3%) experienced flap failure that was ...

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