Medial Femoral Condyle Free Flap for Nasal Reconstruction: New Technique for Full-Thickness Nasal Defects

Abstract

Summary:The nose is a functionally complex organ implicated in breathing, olfaction, and phonation, with a critical role also in the aesthetic appearance of a person. This latter aspect should be carefully considered whenever a total or subtotal rhinectomy is performed for resection of locally advanced nasal cancer. To reconstruct large nasal defects, several techniques were described, including the use of cartilaginous grafts, bony grafts, local flaps, and free flaps. In cases of extensive full-thickness resections, free flaps probably represent the most adequate option. The aim of this report is to present the functional and aesthetical outcomes of a reconstruction of the nose after rhinectomy, using the medial femoral condyle free flap associated with the forehead flap.

Medial femoral condyle free flap in combination with paramedian forehead flap for total/subtotal nasal reconstruction: Level of evidence: IV (therapeutic studies)

“…This type of combined reconstruction, in our hand, demonstrated to be an effective and reliable solution for nasal extended full thickness defects (Cherubino et al, ). The subjective and objective evaluation of both aesthetic and functional outcomes showed an overall pleasing satisfaction rate with minimal donor site discomfort and the aesthetic alteration recorded did not seemed to represent a distressing element in the physiologic facial harmony and the data obtained are in accordance with those present in literature (even though they evaluated smaller nose defects; Arden, Nawroz‐Danish, Yoo, Meleca, & Burgio, ; Mureau, Moolenburgh, Levendag, & Hofer, ; Singh & Barlett, ).…”

Medial Femoral Condyle Flap for Persistent Alveolar Cleft Reconstruction

“…3,5 The MFC flap has been used to reconstruct the nose after rhinectomy, to repair partial or total maxillectomy defects, and repair the premaxilla in a patient with median facial dysplasia. [6][7][8] Gaggl et al have successfully used an osteoperiosteal femur flap to treat defects of the anterior maxillary alveolar ridge after tooth loss in 5 patients with clefts of lip, palate, and alveolus. They then employed the MFC flap as a suitable alternative to repair alveolar ridge defects.…”

“…[2][3][4][5] The MFC flap has also been used to reconstruct craniofacial osseous defects in the nasal bones, maxilla, and mandible. [6][7][8] An alveolar cleft (AC) defect must be repaired to support eruption of the cleft-side lateral incisor and canine, closure of oronasal fistulae, and creation of a continuous maxillary arch. [9][10][11] Successful AC reconstruction requires enough bone stock to achieve alveolar union and depends on the operation's timing, surgical approach, and the bone graft material.…”

A Unique Method for Total Nasal Defect Reconstruction - Prefabricated Innervated Osteocutaneous Radial Forearm Free Flap

“…It is now widely accepted that such defects preclude the use of local flaps and usually need composite microvascular free flaps for inner lining, appropriate suspension framework, accompanied by paramedian forehead flap for external coverage [3]. For inner lining – which is the most difficult to reconstruct - a variety of different free flaps have been described [6, 7]; among them, radial forearm flap is most widely used, yielding a reliable end result [3, 8, 11, 12]. Reconstruction using osteocutaneous radial forearm free flap, has been previously proposed by some authors [4, 9, 10, 13].…”

“…It is stated, that vascularised bone transfer has significant advantages over conventional bone grafting, due to preserved cellular viability [15]. Reconstructed vascularised bone has faster union rate and it tends to have lower absorption rate over time, giving long-term stability [6, 10]. It is now well-known that periostium is of vital importance for bone healing, and reduces incidence of non-union [16].…”