Nasal Reconstruction Using Tissue Expander and Modified Paramedian Forehead Flap Supported by Cartilage Graft

Abstract

This is an interesting case of a male patient with traumatic nasal injury with partial nasal amputation who was referred to our centre 3 months after the initial trauma. The wound was complicated with necrosis, the amputated nose had fallen off and a scar had formed at the wound bed. The nasal defect was greater than 2.5cm in length. More than 50% of the nose had fallen off including the bilateral alar lobule, the tip and the dorsal part of the nose. We utilized a tissue expander to create more tissue on the forehead in view of the patient's short forehead, for donor site closure and to lengthen our flap. We performed a modified paramedian forehead flap with a widened distal portion of flap, in a two-staged nasal reconstruction surgery supported by L-strut cartilage graft harvested from the 7 th rib. In this report we provide an illustrative description of the procedure, its cosmetic and functional outcome and we also share the challenges we faced.