[Cosmetic outcome of nasal tip reconstruction with the frontonasal flap and other locoregional flaps - Cosmetic Outcome of Nasal Tip Reconstruction].

Abstract

Background: This study investigates the results of nasal tip reconstruction with the frontonasal flap compared with other locoregional flaps.

Material and methods: All nasal tip reconstructions with locoregional flaps performed during a 10-year period were included. Defect size, flap type, risk factors, comorbidities, complications, revisions, and secondary operations were retrospectively assessed. Clinical follow-up examinations were performed after 12 months. Digital photographs were taken in standard projections preoperatively and at the time of the last follow-up examination, and the aesthetic results were assessed by three independent examiners, with nasal contour, symmetry, scarring, and match of skin colour between flap and nasal skin rated on a 4-point scale. Finally, patient satisfaction was obtained.

Results: A total of 112 nasal tip reconstructions were performed in 68 women and 44 men with a mean age of 71,4±10,2 years. Taking into account defect size, individual factors and patient preference, reconstruction was performed with 58 frontonasal flaps, 23 Rintala flaps, 20 paramedian forehead flaps and 11 bilobed flaps. Mean age and comorbidities of patients were comparable between flap types, except for a higher incidence of arterial hypertension and a lower incidence of diabetes mellitus in patients treated with frontonasal flaps. Defect size was the same in reconstructions with frontonasal flaps and Rintala flaps, smaller in bilobed flaps, and more extensive in paramedian forehead flaps. There were no differences in complication rates between the different flap techniques. Taking into account the planned second interventions (flap pedicle separations) in the paramedian forehead flaps, the frequency of unplanned corrections was comparable for all flap techniques. Aesthetic results and patient satisfaction were rated as very good or good in more than 90% with all techniques.

Conclusions: Compared with the paramedian forehead flap, the frontonasal flap avoids a planned secondary procedure and an extensive donor defect. It allows for the coverage of defects at least the size of the Rintala flap and larger defects than the bilobed flap.