Reconstruction of the Burned Nose Using an Expanded Skin-Grafted Forehead Flap, Delayed Turnover Flaps, and Indocyanine Green Perfusion Assessment.
Syena Moltaji, Alan D Rogers, Jeffrey Fialkov
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Case in brief
A 35-year-old man developed severe nasal deformity and airway compromise after a flame burn involving about 20% of total body surface area. The lower third of the nose was lost, with deficiencies in lining, structural support, and external soft tissue. Prior split-thickness skin grafts to the forehead and nasal dorsum constrained standard options. Reconstruction combined expansion of the grafted forehead, delayed turnover flaps from grafted dorsal nasal skin for lining, costal cartilage support, and a paramedian forehead flap for coverage. Indocyanine green fluorescence angiography informed intraoperative decisions. Nasal contour and airway patency were restored without flap loss or major complication; the result remained stable at follow-up extending to 10 years.
What made this case unusual
Previously skin-grafted forehead and nasal dorsal tissues were recruited for a complex, full-thickness nasal reconstruction, avoiding microsurgical free tissue transfer.
Diagnostic / clinical pearl
Prior skin grafting does not necessarily preclude use of forehead or dorsal nasal tissue in reconstruction; expansion, staged delay, and intraoperative perfusion assessment supported their use in this case.