Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal Cartilage
Summary:. Nasal reconstruction in very elderly patients is challenging. We attempted subtotal nasal reconstruction with an expanded double forehead flap and autologous costal cartilage support in a 91-year-old woman presenting with subtotal nasal defects after sebaceous carcinoma resection. Only sma...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2021-10-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003868 |
| _version_ | 1818838562837102592 |
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| author | Yuta Nakajima, MD Motonao Iwasawa, MD, PhD Yoshito Mishima, MD, PhD |
| author_facet | Yuta Nakajima, MD Motonao Iwasawa, MD, PhD Yoshito Mishima, MD, PhD |
| author_sort | Yuta Nakajima, MD |
| collection | DOAJ |
| description | Summary:. Nasal reconstruction in very elderly patients is challenging. We attempted subtotal nasal reconstruction with an expanded double forehead flap and autologous costal cartilage support in a 91-year-old woman presenting with subtotal nasal defects after sebaceous carcinoma resection. Only small parts of the bilateral alae and the columella base remained after resection, and the frontal area of the septum was also resected. We planned to use an expanded double forehead flap to reconstruct the whole external skin cover and lining of the nose. We chose a 200-mL tissue expander and injected 152 mL of saline over 15 weeks. The expansion course in this patient was slower than that in younger patients because of the limited expansibility of her forehead skin. However, the skin tolerated the repeated expansions well, and the double forehead flap was expanded to the planned size preoperatively. The nasal support grafts were composed of the L-strut and alar battens from the eighth and ninth costal cartilages, and were fixed using nonabsorbable sutures. Histological examination revealed cartilage matrix degeneration and a reduced number of living chondrocytes, yet no calcification or fragility. After 18 months of follow-up, the framework maintained its shape, and the dorsum was straight without warping. The autologous costal cartilage provided a natural nasal shape and nostrils. Thus, an expanded double forehead flap with careful tissue expansion and a rib cartilage graft can allow natural nose reconstruction without a microvascular technique in very elderly patients. |
| first_indexed | 2024-12-19T03:40:23Z |
| format | Article |
| id | doaj.art-230f8088e73b46e9b2d8081b61bc0228 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-19T03:40:23Z |
| publishDate | 2021-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-230f8088e73b46e9b2d8081b61bc02282022-12-21T20:37:14ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742021-10-01910e386810.1097/GOX.0000000000003868202110000-00029Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal CartilageYuta Nakajima, MD0Motonao Iwasawa, MD, PhD1Yoshito Mishima, MD, PhD2From the * Department of Plastic and Reconstructive Surgery, Japanese Red Cross Society Nagano Hospital, Nagano, Japan‡ Department of Plastic and Reconstructive Surgery, Japanese Red Cross Society Iiyama Hospital, Iiyama, Japan.From the * Department of Plastic and Reconstructive Surgery, Japanese Red Cross Society Nagano Hospital, Nagano, JapanSummary:. Nasal reconstruction in very elderly patients is challenging. We attempted subtotal nasal reconstruction with an expanded double forehead flap and autologous costal cartilage support in a 91-year-old woman presenting with subtotal nasal defects after sebaceous carcinoma resection. Only small parts of the bilateral alae and the columella base remained after resection, and the frontal area of the septum was also resected. We planned to use an expanded double forehead flap to reconstruct the whole external skin cover and lining of the nose. We chose a 200-mL tissue expander and injected 152 mL of saline over 15 weeks. The expansion course in this patient was slower than that in younger patients because of the limited expansibility of her forehead skin. However, the skin tolerated the repeated expansions well, and the double forehead flap was expanded to the planned size preoperatively. The nasal support grafts were composed of the L-strut and alar battens from the eighth and ninth costal cartilages, and were fixed using nonabsorbable sutures. Histological examination revealed cartilage matrix degeneration and a reduced number of living chondrocytes, yet no calcification or fragility. After 18 months of follow-up, the framework maintained its shape, and the dorsum was straight without warping. The autologous costal cartilage provided a natural nasal shape and nostrils. Thus, an expanded double forehead flap with careful tissue expansion and a rib cartilage graft can allow natural nose reconstruction without a microvascular technique in very elderly patients.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003868 |
| spellingShingle | Yuta Nakajima, MD Motonao Iwasawa, MD, PhD Yoshito Mishima, MD, PhD Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal Cartilage Plastic and Reconstructive Surgery, Global Open |
| title | Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal Cartilage |
| title_full | Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal Cartilage |
| title_fullStr | Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal Cartilage |
| title_full_unstemmed | Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal Cartilage |
| title_short | Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal Cartilage |
| title_sort | subtotal nasal reconstruction in a 91 year old patient expanded double forehead flaps and costal cartilage |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003868 |
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