Total nasal reconstruction: use of a radial forearm free flap, titanium mesh, and a paramedian forehead flap.

BACKGROUND: reconstruction of a total nasal defect presents a significant challenge to the reconstructive surgeon. The form, function, and aesthetic appeal of all the nasal subunits must be addressed. Classic teaching emphasizes the importance of restoring the internal lining of the nose, the rigid scaffolding, and the outer skin and soft tissue layer.

METHODS: a restrospective review was undertaken in eight patients who had undergone total nasal reconstruction in two Canadian tertiary care centres. All eight patients had their nasal defect reconstructed with a radial forearm free flap for internal lining, titanium mesh for structural support, and a paramedian forehead flap for skin and soft tissue cover. Nasal function, graft survival, patient satisfaction, and complications were recorded.

RESULTS: seven of eight patients were satisfied with the cosmetic outcome of their nasal reconstruction. Two patients reported poor nasal breathing owing to nasal stenosis. Two cases of minor titanium extrusion required operative intervention for repair. There were no cases of loss of the radial forearm free flap or paramedian forehead flap in this series.

CONCLUSIONS: reconstruction with a radial forearm free flap, titanium mesh, and a paramedian forehead flap is a reliable, cosmetically appealing, and functional method for total nasal reconstruction. Minor surgical revisions should be anticipated to achieve the best cosmetic outcome. This is the first reported series using these three entities together to reconstruct total and subtotal rhinectomy defects.