Reconstruction of very large nasal septal defects with a preformed forearm fascial flap

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Background The reconstructive surgery of large nasal septal defects is considered one of the most demanding tasks in our specialty. The repair alone with local material is not successful, a closure with pedicled mucosal flaps, e.g. from the oral cavity, is usually unreliable despite pre-cutting. The use of a free radial forearm flap is considered relatively safe. However, it is quite thick and has cornified squamous epithelium on one side, an unfavorable situation in several respects. Patients and method We report a 2-stage surgical technique involving the use of the radial forearm fascia as a free microvascular graft preformed with a concha or costal cartilage graft. So far we have been able to operate on 3 patients with very large septal defects measuring more than 3 cm. Results The defects could be completely closed in all patients. The free flap was epithelized within 4 to 6 weeks postoperatively. The incrustation tendency improved considerably, as did the nasal breathing. There were no problems in the lifting regions on the auricle, chest and forearm. Conclusion The 2-stage technique we have described for the reconstruction of large Nasal septal defects proves to be safe and low-risk. The advantages over the known use of the complete radial forearm flap are the reduced thickness and the relatively quick improvement in nasal breathing, including the crusting tendency of the nose, which was felt to be particularly stressful preoperatively. G Savona, J Inhestern, R Magritz Publication History Article published online: 12 May 2023 Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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