1. The free flap for burned nose reconstruction 游離皮瓣在燒傷鼻部重建的應用
顏琤嬑 楊瑞永 黃嫆茹 吳至偉 楊士毅 陳宏彰 張淑茵 莊秀樹 蕭彥彰
林口長庚醫院整形外科

2. Burned nose Short nose with alar flaring alar margins nasal tip
Columella
Nostril
Vestibule
Dorsum scar

3. Challenging Associated facial injury Local flap
Nasolabial flap
Cheek advancement flap
Paramedian forehead flap
Tissue expander
Scar tissue

4. Purpose
Free flap
Full thickness nasal defect after burn injury

5. Patients
1998/08 ~ 2015/09
6 patients
7 free flaps for burned nose reconstruction
4 ulnar forearm flap
1 radial forearm flap (face and nose, acute stage)
1 anterolateral thigh flap
1 medial sural artery perforator flap

6. Demographics Age 25.2 years old (7~37) Mechanism of burn TBSA 4% ~48%
2 flame burn, 2 chemical burn, 1 explosive burn, 1 contact thermal burn
TBSA 4% ~48%
face and forehead all involved
Duration from injury to nose reconstruction:
1 acute stage (6 days)
10 years (3~18 years)

7. Reconstruction Skin Lining Framework Excise the contracture scar
Subunit principle
Lining
Turnover flap from scars on alar and columella
Framework
Autogenous rib cartilage
Reinforcement
Alar rim graft, dorsal onlay graft, columellar struct

8. Reconstruction Template Flap size: 5cm x 7cm ~ 7 x 8cm (12cm x 5cm)
6 Skin envelope and 1 partial lining
Recipient vessel
facial artery and vein/ superficial temporal artery and vein
Pedicle length: 10 cm - 12 cm

9. Reconstruction Donor site No circulation problems
ALT primary closure
Others skin graft
No circulation problems
No early complications
Discharge within 2 weeks

10. Refinement Follow-up : 59 months (16 ~126 months)
Refinement operations: 4.5 times (2 ~7)
Satisfactory aesthetic and functional outcomes

11. Complication 1 partial necrosis 1 infection
1.5 months after debulking procedure
Replaced by another free flap
1 infection
3 months after reconstruction
Remove rib cartilage
Replaced with alloplastic implant for dorsum 1 year later

12. Case presentation

19. Discussion Secondary reconstruction Aesthetic unit Framework
Refinement
Patch-like looking

20. Conclusion
In terms of limited local tissues for nasal reconstruction after severe facial burn injury, free flap serves as an applicable choice to restore nasal lining and skin envelope , with rebuilding of nasal framework could be performed at same stage.
Through thoughtful planning and sufficient refinement, satisfactory aesthetic and functional results are achievable.