Complete three-stage nasal reconstruction

Complete three-stage nasal reconstruction

Case presentation:

Extended melolabial flap, rib graft and composite auricular graft

A patient who had previously undergone two open rhinoplasties, presenting with complete necrosis of the columellar complex and the caudal septum, associated with severe anatomical and functional nasal impairment.

After evaluating the various reconstructive options, a three-stage reconstruction was chosen, using an extended melolabial flap combined with cartilage grafts.

First phase:

Structural restoration and roofing

1

Doppler ultrasound

Identification of the course of the facial artery to plan the flap.

2

Preparation of the receiving bed

Debridement and examination of the lining revealed complete collapse of the left internal nasal valve, affecting the scroll region and the alar cartilage.

3

Compound ear graft

Obtained from the shell to reconstruct the inner lining of the nose.

4

Costal graft

Harvesting cartilage from the ninth right rib to restore columellar support.

5

Extended melolabial flap

Dissection, rotation and adjustment of the flap to reconstruct the external covering of the columella.

Second phase:

5 weeks

Fat removal and reduction of the flap to improve its fit and anatomical definition.

Third half:

8 weeks

Cross-section of the pedicle and final reshaping of the flap to complete the columellar reconstruction.