Abstract
Introductions
Interpolated flaps remain the mainstay of nasal reconstruction. In this regard Paramedian forehead flap has been combined and modified variously by different surgeons. However, still multiple stages are required to give shape to the nose and ensure that skin and cartilaginous vault of nose are aesthetically and functionally reconstructed. However, we describe a technique in which cartilage is reconstructed at the same stage as harvesting the flap without risk of vascular compromise.
Materials and Methods
We describe a retrospective chart review of reconstructive nasal procedure in 2 stages with reconstruction in the first sitting itself using Paramedian forehead flap and ipsilateral septal perichrondium and septal cartilage in 4 patients of lower nasal vault deficiency between Jan 2018 to Dec 2018. The patients age ranged from 10 to 67 Years. 2 of the patients needed surgery due to dog bite injury 1 due to excision of basal cell carcinoma and another due to road traffic accident. The technique involved harvesting an ipsilateral paramedian forehead flap along with ipsilateral septal perichondrial flap anteriorly based and using septal cartilage to make the skeleton. The flap was divided after 3 weeks and thinned suitably.
Results
All the patients reported complete uptake of flap without any cartilage necrosis. Functionally none of the patient reported more nasal block than that seen preoperatively. The average NOSE VAS score remained 17.5 reported 1 month after the second stage.
Conclusions
Planning is the key for appropriate and cosmetically feasible nasal con-struction. Emphasis must be given to nasal subunit being reconstructed and the choice of flap must be robust. Our forehead flap uses 2 stage design with septal flap to allow for cartilage reconstruction in situ. We utilized post op small vessel dilators along with BACTIGRAS dressings to prevent infection. Our technique in both cases allowed for a greater nasal airway and greater nasal valve suppor.t
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Acknowledgements
This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Gujarat Adani Institute of Medical Sciences Bhuj approved this study and the approval number is GAIMS/IEC/APPROVAL/1/2019 Date: 26/01/2019
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr.Mohit Sinha, Dr. Narendra Hirani and Dr.Ajeet Khilnani. The first draft of the manuscript was written by Dr. Mohit Sinha and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Sinha, M., Hirani, N. & Khilnani, A.K. Reconstructive Rhinoplasty—Our Experiences at a Rural Medical College in Gujarat. Indian J Otolaryngol Head Neck Surg 74 (Suppl 2), 1701–1705 (2022). https://doi.org/10.1007/s12070-021-02835-y
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DOI: https://doi.org/10.1007/s12070-021-02835-y