Reconstruction methods for and cosmetic evaluation of external nasal tumour resections: flap versus graft.

Nose reconstruction is challenging given the three-dimensional structure and free edge, and various methods have been reported. In general, local flaps provide cosmetic outcomes that are better than those following skin grafts, but there are no published comparative studies on Asians. To determine whether local flaps or skin grafts may optimally be used to reconstruct external nasal defects among Asians. We retrospectively collected data on patients who underwent external nasal tumour resection and reconstruction by 14 plastic surgeons in eight Japanese institutes from 2009 to 2021. The cosmetic results were scored by 14 surgeons using anonymized preoperative and six-month postoperative photographs. Scores for each reconstruction method were statistically evaluated. In total, 86 cases were enrolled; 57 received local flaps and 29 received skin grafts. Most local flaps showed better outcomes compared to skin grafts, but this was not the case for nasolabial and forehead flaps. Notably, local flaps placed in the nasal ala tended to be less successful than flaps placed elsewhere; only the bilobed flap scored better than skin grafts. The defect site did not affect the results of skin grafts. For Asians requiring nasal reconstruction, local flaps provide better cosmetic outcomes than skin grafts, except for those in the nasal ala. Skin grafts may be a good alternative when the bilobed flap is unavailable for the nasal ala.

Can a true perforator flap survive on venous blood? A case report of anterolateral thigh true perforator flap supplied by antegrade venous inflow.

In some cases of degloving injury, as a result of multiple venous anastomoses formed on the peripheral and proximal sides, the detached flap skin did survive, though with patchy necrosis. On the basis of this experience, the skin and soft-tissue defects after removing skin cancer were closed with an anterolateral thigh true perforator flap, measuring 4 × 5 cm in size, which is nourished by venous blood. The subcutaneous vein on the peripheral side of the defect was anastomosed to the perforator artery, and the veins on the proximal side of the defects were anastomosed to the concomitant veins of the perforator. After surgery, to ensure a sufficient blood flow to the flap, the affected limb was positioned lower than the heart for 1 week. To prevent microthrombus in the perforator branch and the flap, preventive anticoagulant therapy was performed. The transplanted flap had marked cyanosis for a few days, but turned pinkish on the sixth day after surgery. The flap survived completely. As opposed to venous flaps reported in the past, the physiologic direction of blood flow of the flap is from arteries to veins, and it is nourished exclusively by venous blood. If a flap is small, and there are no appropriate recipient vessels nearby, this method could serve as a favorable alternative.