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Plastic and Reconstructive Surgery

Complex Nasal Reconstruction: Methods to Avoid a Forehead Flap

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Introduction/Purpose: Approximately 4.7 million people are bitten by dogs every year, of which 44,000 were facial injuries.1 Facial dog bite injuries can include damage to the soft tissues but the unique architecture and lack of tissue for mobilization make closure of nasal defects challenging. We demonstrate how nasolabial flaps can be used in place of forehead flaps for reconstruction of multiple nasal subunits including the tip and columella .

Methods or Case Description: A 26-year-old male presented following a facial dog bite in which he sustained a large soft tissue avulsion involving multiple nasal subunits. Options for nasal reconstruction including the forehead flap were discussed with him. To limit additional visible, scarring coverage was provided with a nasolabial flap.

Outcomes: In general, a paramedian forehead flap offers coverage of all the nasal subunits, at the expense of a vertical forehead scar. For patients wishing to avoid a vertical scar, the nasolabial flap is an excellent choice. Historically, the nasolabial flap is described for resurfacing of alar defects; however, as presented here it can be used to resurface other nasal subunits as well. One of the major benefits of a nasolabial flap is the ability to camouflage the scar within the nasolabial fold. The flap is also durable, allowing for coverage of cartilage reconstruction.

Conclusion: The nasolabial flap is an excellent option of nasal reconstruction; however, there are some limitations of the nasolabial flap. While we have proven its ability to resurface the ala, nasal tip, and columella, it is unlikely that it will reach the dorsum. As seen in this case presentation, the nasolabial fold should not be discounted as an excellent option for reconstruction of multiple nasal subunits.

    Poster Presenter(s)

  • Mickel J. Voigt

    Medical Student
    Philadelphia College of Osteopathic Medicine
    Philadelphia College of Osteopathic Medicine
    Philadelphia, PA, US

    • Author(s)

  • KH

    Kayla Humenansky, DO

    Philadelphia College of Osteopathic Medicine
    Philadelphia, PA, US