Pivoted composite nasal septal flap for reconstruction of the nose
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RHINOLOGY
Pivoted composite nasal septal flap for reconstruction of the nose M. K. Aneeshkumar • Kristelle Chueng • Rob Hart • Jonathan Trites • Mark Taylor
Received: 25 September 2012 / Accepted: 9 January 2013 / Published online: 22 January 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Reconstruction of nasal tip support and internal lining after excision of nasal carcinoma is challenging. Since its original description by Menick in 1989, the outcomes of bipedicled septal pivot flap are rarely reported in the literature. Objective of this work is to review our results using the Septal pivoted flap in nasal reconstruction. It is a retrospective case series, Dalhousie University, Halifax, Nova Scotia. We studied six patients who underwent significant resection of the tip and dorsum of the nose for squamous or basal cell carcinoma. All involved nasal subunits were removed. Nasal reconstruction was subsequently performed using an inferiorly bipedicled pivoted composite nasal septal flap combined with a regional flap for skin coverage. The bipedicled SPF provided excellent support of the nasal tip in all six cases. All flaps in the cohort survived. Five patients
This paper was presented as poster at the Canadian Society of Otolaryngology Head and Neck Surgery Conference on 20–22 of May 2012 at Toronto. M. K. Aneeshkumar K. Chueng R. Hart J. Trites M. Taylor Division of Otolaryngology-Head and Neck Surgery, Division of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada e-mail: [email protected] R. Hart e-mail: [email protected] J. Trites e-mail: [email protected] M. Taylor e-mail: [email protected] M. K. Aneeshkumar (&) Otolaryngology-Head and Neck Surgery, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK e-mail: [email protected]
had good mucosal lining from the septal flap alone and only one patient required a concurrent pericranial flap. Three patients experienced bleeding and required additional nasal packing. A bipedicled septal pivoted flap is exceptionally useful in providing a good tip support and well-vascularized nasal lining for reconstruction after major resection of the nasal tip. Bleeding is common and should be anticipated in the majority of patients. Keywords Nasal septal flap Composite flap Nasal reconstruction
Introduction Excision of nasal carcinoma results in a range of nasal defects. In order to reduce the incidence of recurrence, a full-thickness excision including the skin, cartilage and mucosa with adequate margins is sometimes required. A subtotal or total rhinectomy is indicated in more aggressive cases of cancer invading the nasal skin or cancer involving the nasal septum and columella [1]. Based on the reconstructive ladder the options for aesthetic and functional outcome could range from healing by secondary intention to free flaps. Regional flaps are the preferred method of reconstruction since they provide a good colour and thickness match to the nasal skin. The paramedia
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