Medial Femoral Condyle Free Flap for Nasal Reconstruction: A New Technique for Full Thickness Nasal Defects.

The nose is a functionally complex organ that plays a critical role in breathing, olfaction and phonation with a relevant part also in aesthetic self-acceptance. The reconstruction of full-thickness nasal defects necessitates the restoration of all the three nasal layers. Since no ideal donor site can provide all these tissues in a single step, generally several procedures need to be performed; for this reason, secondary, surgical refinements are frequently required to achieve a harmonious nasal contour. However, in some cases, long term stability cannot be granted due to partial graft reabsorption. The medial femoral condyle free flap (MFCf) represents a suitable solution as it allows the simultaneous reconstruction of both the mucosal and skeleton layer. During the same surgical procedure, a forehead flap is performed to cover the external nose layer, thus allowing the reconstruction of the nasal pyramid main frame to take place in a single stage. The MFCf provides a thin cortico-periosteal tissue that can be easily fold in a roof-like shape without hampering its vascular network.

Materials and methods:

Since November 2015 seven patients with a full-thickness nasal defect underwent nasal reconstruction using the MFCf and a combined forehead flap. The periosteum of the MFCf was used to replace the internal lining while the cortical bone to restore the scaffold. The bone was stabilized with titanium mini plates and then a forehead flap was harvested for the external layer. Outcomes were assessed through a questionnaire about the patients' postoperative quality of life (Derriford Appearance Scale 24).

Results:

All patients were satisfied. No secondary debulking procedures was needed. Follow-up was 7-24 months.

Conclusion:

The MFCf associated with a simultaneous forehead flap allows the reduction of the numbers of surgical procedures. The MFCf represents a valid surgical option to successfully manage full thickness nose defects, allowing a reliable contour stability over time.