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SM12: Nasal Reconstruction after Cancer Treatment Includes Variety of Options

by Thomas R. Collins •

But there are caveats, including a higher incidence of lympedema, causing a raising, or “pincushioning” of the skin.

“Once you have the pincushion, it’s very hard to deal with at times,” he said. “It may linger for quite some time and can be very difficult to manage.” Also, the incisions cannot be placed to be as well-hidden as in the case with some rotation flaps and they’re sometimes called a “number 3” flap for the shape of the scar that’s left behind.

“My patients are all geared up. Talking them into waiting another week to 10 days is not really what they’re looking for.”

—William Shockley, MD

Reiger Flap

Dean Toriumi, MD, head of facial plastic and reconstructive surgery at the University of Illinois at Chicago, said the Reiger, or nasoglabellar, flap, works best for defects that sit at an angle over the lower third of the nose. It’s especially useful if the defect is oblong in shape, he said.

With this flap, the superior component of the flap is located over the glabella and runs down the side of the nose to the site of the defect. The flap is shifted down and to the side, into the defect near the bottom portion of the nose.

Transposition of the flap can create a “dog ear deformity” near the pivot point of the flap, and it may be wise to wait to excise that skin, depending on its location, particularly if it’s close to critical blood vessels, Dr. Toriumi said. That subsequent excision can be done in the office under local anesthesia a week or two later. This kind of flap also works best for patients with thinner skin, he said.

Paramedian Forehead Flap

For noses with several defects, the paramedian forehead flap is a good option, said Brian Wong, MD, director of facial plastic surgery at the University of California, Irvine. With this flap, forehead skin is rotated over the defects in the nose. A template is used to cut the exact shape of the flap that’s needed. This flap is also a good candidate for total nasal reconstruction and for reconstruction of the tip, Dr. Wong said.

He said the pedicle should be at least 1.2 cm wide. He also said he uses a Doppler to trace the blood vessel out before his procedures. “It allows you to bring a lot of tissue a very long distance,” he said.