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Reconstruction of Larger Nasal Defects using Tip Divided-Scalping Forehead Flap | OMICS International
ISSN: 2157-7552
Journal of Tissue Science & Engineering

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Reconstruction of Larger Nasal Defects using Tip Divided-Scalping Forehead Flap

Yoshihiro Sowa* and Toshiaki Numajiri

Departments of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto 602-8566, Japan

Corresponding Author:
Yoshihiro Sowa
Department of Plastic and Reconstructive Surgery
Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences
Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto 602-8566, Japan
Tel: 81-75-251-5730
Fax: 81-75-251-5732
E-mail: [email protected]

Received date: October 14, 2015; Accepted date: February 03, 2016; Published date: March 21, 2016

Citation: Sowa Y, Numajiri T (2016) Reconstruction of Larger Nasal Defects using Tip Divided-Scalping Forehead Flap. J Tissue Sci Eng 7:166. doi:10.4172/2157-7552.1000166

Copyright: © 2016 Sowa Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The scalping forehead flap, first reported by Converse in 1942 [1], is one of the best techniques for total and subtotal nasal reconstruction because this flap is extremely reliable and provides skin of good quality and colour-match [2]. We introduce the technique and refinements of nasal reconstruction for defects together with the nasal lining and the upper lip by using the divided distal part of the scalping forehead flap. This method provides adequate tissue for large and three-dimensional defects in a one-stage procedure.

The flap is elevated, as described by Converse [1], beginning from the selected side of the forehead in the subcutaneous plane, superficial to the frontalis muscle.

In this manner, the selected part of the forehead, which will be used to cover the defect, is split vertically into the two flaps (flap X and Y). The upper lip and right-nostril floor is constructed with the lateral flap: Flap X; and the extra nasal structure with the medial-side flap: Flap Y. First, transferring the Flap X to the defect in the lower half of the nose and upper lip, which the local lining flaps could not cover, by rotation and advancement, allows the upper lip and right-nostril floor to be reconstructed. Next, flap Y is transferred to the nasal area, where the distal part of the flap is trimmed, depending on the defect size (Figure 1).


Figure 1: Schematic illustration of the tip devided-scalping forehead flap.

The pedicle is usually divided, after an interval of 2 or 3 weeks days. When appropriate, late revisions can be performed, such as flap defatting, configuration of the nostril symmetry, and restoration of the nasal framework, thus improving the esthetic appearance of the nose.

We introduce one representative case of squamous cell carcinoma (SCC) on the medial floor of the right nasal cavity. A complete tumoral resection was performed with a distance of 1cm or more from the tumor, including the ala base, tip, colmella, and full thickness of the upper lip (Figure 2a).


Figure 2: (A) Preoperative design of tip devided-scalping forehead flap. (B) Elevation of the flap. (c) intraoperative view of flap setting. (C) post-operative result at 1 year.

We reconstructed the upper lip and right-nostril floor with the Split- Scalping forehead flap (Figure 2b,c).After the operation, mild venous congestion was observed in the tip of flap X, but it improved within 6 days. 18 days later, the flap divided after delay procedure was added substantially. The aesthetic and functional results were acceptable, except for a slightly slanted nose and contracture of the upper lip due to a twisting effect of the flap X (Figure 2d).

This refinement surgical technique has the following advantages 1) the forehead is adjacent to the upper lip, as well as the nose, it has similar color and texture and it has an excellent and reliable blood supply. 2) The flap can provide sufficient tissue as a result of a single flap in a one-stage procedure. 3) This technique reduces the operation time and the number of donor sites. However, the following points still remain as minor problems:1) after the operation, venous congestion was observed in the distal third of flap X, owing to twisting and insetting of the flap, though gradual improvement is found within 5 days. 2) Little raw surface remained, especially on the back wall of the upper lip. Therefore, the mucosal flap or skin graft should sometimes be used to avoid contracture of the lip.


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