• Archives of Plastic Surgery
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• v.40 no.6
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• pp.748-753
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• 2013

Background Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction. Methods Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia. Results Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary. Conclusions This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.46-49
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• 2012

Purpose: The forehead flap is the workhorse in nasal reconstruction, which provides a similar skin color, texture, structure, and reliability. There are some disadvantages, including donor site morbidities, 2- or 3-stage operations, and postoperative management after initial flap transfer. Furthermore, there has been little attention to the exposed raw surface wound, after the first stage of an operation. This article describes the authors' modification to overcome this problem, using artificial collagen membrane. Methods: An Artificial collagen membrane is composed of an outer silicone membrane and an inner collagen layer. After a forehead flap elevation, the expected raw surface was covered by an artificial collagen membrane with 5-0 nylon suture. A simple dressing, which had been applied to the site, was changed every 2 or 3 days in an outpatient unit. At 3 weeks postprocedure, a second stage operation was performed. Results: With biosynthetic protection of the raw surface, there were no wound problems, such as infection or flap loss. Thus, the patient was satisfied due to an effortless management of the wound and a reduction in pain. Conclusion: The application of an artificial collagen membrane to the raw under-surface of the flap could be a comfortable and a protective choice for this procedure.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.259-265
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• 2018

Background Forehead flaps are useful for facial reconstruction. Studies of these flaps have mostly focused on the results of the reconstruction. However, due to the scarring and changes on the forehead caused by the median forehead flap (MFF), surgeons may be reluctant to perform this flap. Research into the donor site is needed for practical purposes. Methods We examined 42 patients who underwent an MFF at Pusan National University Hospital from 1996 to 2016. Based on a retrospective chart review, we examined the occurrence of complications. We also evaluated scars on the forehead using the Vancouver Scar Scale (VSS) and assessed changes in the eyebrow position of 22 patients. Results No complications occurred in the 42 patients. The mean VSS score of the 22 patients was $2.8{\pm}0.79$. The ratio of the height of the eyebrow on each side to the distance between the medial canthi increased postoperatively, meaning that both the left and right brows were elevated slightly (P=0.026 and P=0.014). However, the symmetry between the left and right sides did not change (P=0.979). The ratio of the interbrow distance to the distance between the medial canthi decreased slightly, meaning that the interbrow distance narrowed mildly (P<0.001). Moreover, there were no noticeable changes in the brow position as seen in a photo overlay. Conclusions There were no notable complications in the forehead. Forehead scarring was acceptable. No change in brow symmetry was observed via photographic measurements and a photo overlay. Therefore, we propose that the MFF is a useful choice for minimizing scarring or deformation of the donor site.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.4
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• pp.350-355
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• 2005

There are various surgical methods for reconstruction of the nasal defect. Among them, there is some difference in the choosing the proper reconstruction method according to defect size and position. When the defect involved the tip, the columella, and the alar, the local flaps may be preferred, because they can provide sufficient amount of tissue. However, the composite grafts from the ear have been effectively used in reconstructions of smaller sized defects of the columella and ala. We excised total external nose because of squamous cell carcinoma on the nasal tip, columella, and nasal septum. We reconstructed the nasal tip, both alae, and columella with forehead flap. After division of the regional flap, we found partial necrosis of the columella and narrowness of the nostril. So, we used chondrocutaneous auricular composite grafts for reconstruction of the columella and both nostrils. We used the file-folder designed auricular composite graft for reconstruction of columella and the wedge shaped ear helical composite grafts for widening of nostrils. 6 months later, there were no significant problems, except some mismatched dark color in the grafted alar tissues. Here, we report a successful reconstruction of large nasal defect using combined two different reconstructive methods.

• Korean Journal of Head & Neck Oncology
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• v.6 no.2
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• pp.79-84
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• 1990

This paper is a review of our experience with radical resection for cancer of the oral cavity with particular emphasis upon the value of myocutaneous(i.e., musculocutanous) flaps employed in the surgical reconstruction in patient survival. During the past 15 years, 98 patients underwent resection of cancer arising in the oral cavity and oropharynx. Of these, 14 had composite resections in which the mandible was not sectioned, and 4 underwent en bloc resections without neck dissections in the face of post-radiation recurrence. When these excluded, 84 patients who underwent COMMANDO procedures with or without myocutaneous flaps were suitable for analysis of recurrence and survival according to the various surgical technics employed. 1) According to the surgical technic, there were 24 standard COMMANDO procedures in whom no regional or myocutanous flap was used; 12 patients who underwent reconstruction employing a forehead flap; 19 patients in whom a posterior cervical 'nape' flap was employed; 27 patients who underwent myocutaneous or osteo-myocutaneous flap repair; and two patients who had double flap repair. 2) The uncorrected two-year disease free survival was 41% for standard COMMANDOs, 17% for forehead flap COMMANDOs; 35% for nape flap COMMANDOs; and 35% for myocutaneous flap COMMANDO procedures. 3) The two-year disease-free survival by Stage was 100% in Stage I, 45% in Stage II, 41% in Stage III, and 18% in Stage IV. 4) When myocutanous flaps cases were compared with Group I, comprised of matched historical controls including both Standard COMMANDOs and those who had undergone regional flap repairs(that is, forehead and nape flap COMMANDOs)there was no difference, both groups showing a 40% 2-year disease-free survival. 5) When musculocutanous flap cases were compared with Goup II, which was composed of matched historical controis limited to patients who had undergone regional flap repairs(that is, forehead and nape flap cases only)there was no difference, both groups showing a 27% 2-year desease-free survival. 6) When musculocutanous flap cases were compared with Group III, composed of patients who had undergone classic COMMANDO procedures without any sort of flap repair, there was a striking difference; the patients undergoing MC flap repair showed 50% 2-year disease-free survival, whereas the classic COMMANDO cases showed a 25% survival free of disease. 7) Locoregional recurrence was also evaluated in the four categories; for standard COMMANDO cases it was 25%, for nape flap cases 26% ; for forehead flap cases, 33%, and for the musculocutaneous flap cases, the lowest recurrence rate, 22%. These results are of particular significance in view of the fact that the proportion of advanced cases(Stage III and IV)in each category was 67% of standard cases, 79% of nape flap patients, 100% of forehead flap cases, and 96% of musculocutaneous flap cases.

• Journal of the Korean Burn Society
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• v.24 no.2
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• pp.60-63
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• 2021

In the face, the nose plays an important role in both function and appearance. Among the subunits on the nose, the alar is a critical nasal structure of high aesthetic value. Previously, many surgeons have insisted that structural support should be added to the reconstruction of alar and particularly so in the case of a full-thickness defect. In a 58-year-old male patient who had a third-degree burn injury and full-thickness defect in most of the left nasal alar, forehead flap surgery alone was successfully performed without structural support.

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.190-197
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• 2016

Background: The cheek rotation flap has sufficient blood flow and large flap size and it is also flexible and easy to manipulate. It has been used for reconstruction of defects on cheek, lower eyelid, or medial and lateral canthus. For the large defects on central nose, paramedian forehead flap has been used, but patients were reluctant despite the remaining same skin tone on damaged area because of remaining scars on forehead. However, the cheek flap is cosmetically superior as it uses the adjacent large flap. Thus, the study aims to demonstrate its versatility with clinical practices. Methods: This is retrospective case study on 38 patients who removed facial masses and reconstructed by the cheek rotation flap from 2008 to 2015. It consists of defects on cheek (16), lower eyelid (12), nose (3), medial canthus (3), lateral canthus (2), and preauricle (2). Buccal mucosa was used for the reconstruction of eyelid conjunctiva, and skin graft was processed for nasal mucosa reconstruction. Results: The average defect size was $6.4cm^2$, and the average flap size was $47.3cm^2$. Every flap recovered without complications such as abnormal slant, entropion or ectropion in lower eyelid, but revision surgery required in three cases of nasal side wall reconstruction due to the occurrence of dog ear on nasolabial sulcus. Conclusion: The cheek rotation flap can be applicable instead of paramedian forehead flap for the large nasal sidewall defect reconstruction as well as former medial and lateral canthal defect reconstruction.

• Journal of the Korean Burn Society
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• v.24 no.1
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• pp.14-17
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• 2021

The nose is a complex three-dimensional structure and represents a major aesthetic focus of the face. As a gold standard for nasal soft tissue reconstruction, the 'forehead flap' provides reconstructive surgeons a robust pedicle and large amount of tissue to reconstruct almost any defect. However, during this process, some hair can be unintentionally introduced to the nose. Accordingly, laser hair removal is sometimes needed, but blood circulation and flap survival should be carefully monitored. Despite careful evaluation, a third-degree burn occurred in our patient that required eight weeks to heal. Here, we report on a burn resulting from epilation conducted 2 weeks after forehead flap for nasal reconstruction.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.13-18
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• 2010

Purpose: Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps. Methods: From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor (18 cases), trauma (11 cases), inflammation from foreign body reaction (5 cases) and congenital malformation (2 cases). The sites of the defects were ala (22 cases), nasal tip (8 cases) and dorsum (6 cases). The thickness of the defects was skin only (5 cases), dermis and cartilagenous layer (7 cases) and full-thickness (24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below $0.25 cm^2$ were covered with composite graft or full-thickness skin graft. Results: The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match. Conclusion: The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.

• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.87-90
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• 2002

Malignant melanoma of the nasal cavity occurs rarely. Malignant melanoma, originated from the upper respiratory tract including nasal cavity, has clinical feature of local recurrence and easily metastasizes to regional or distant lymph nodes, lung, and liver. Malignant melanoma originated from nasal cavity frequently shows tumor cell invasion, ulceration, or infection. Owing to these characteristics, complete surgical excision of the malignant melanoma in nasal cavity is not easy. And also the prognosis of this tumor is not so good because of a high recurrence rate. Recently the authors have recently experienced a case of malignant melanoma originated from the inferior turbinate, which was treated with lateral rhinectomy, total maxillectomy. The defect developed after surgical extirpation was reconstructed with rotational forehead flap.