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Microvascular Reconstruction of the Nose with the Radial Forearm Flap: A 17-Year Experience in 47 Patients

Salibian, Arthur H. M.D.; Menick, Frederick J. M.D.; Talley, John M.D.

Plastic and Reconstructive Surgery: July 2019 - Volume 144 - Issue 1 - p 199-210
doi: 10.1097/PRS.0000000000005777
Reconstructive: Head and Neck: Original Articles
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Background: Microvascular reconstruction of the nose was pioneered in China in the early 1970s using the radial forearm flap. Since then, different flaps, methods, and flap designs have been used to improve outcomes. Microvascular tissue transfer has become the first step of multistage reconstruction, which includes rebuilding the nasal framework, transferring a forehead flap for external skin coverage, and sculpting the nose for improved appearance and breathing. In this article, the authors present their long-term experience in microvascular reconstruction of the nose using the infolded radial forearm flap for full-thickness nasal defects, and a single circumferential flap for inner lining only.

Methods: Fifty microvascular nasal reconstruction procedures were performed on 47 patients between 2000 and 2017 using the radial forearm flap. The reconstructions included total/subtotal nasal defects using a trapezoid-shaped forearm flap folded in one or two planes, and a rectangular flap positioned internally and circumferentially for lining only. The nasal defects were caused by cancer resection, trauma, infection, cocaine abuse, and failed attempts at nasal reconstruction.

Results: Forty-seven flaps were transferred successfully for nasal reconstruction, with two immediate failures (4 percent) caused by flap insetting complications and one late loss. Forty-six patients completed the multistage nasal reconstruction. Follow-up was 1 to 17 years (average, 6 years).

Conclusion: The radial forearm flap infolding technique is the authors’ method of choice for microvascular reconstruction of the nose because it allows placement of a primary dorsal cartilage graft for optimal vascularization, and uses the excess dorsal skin during forehead resurfacing to modify the lining inset and shape the nostrils.


Orange and Palo Alto, Calif.; and Tucson, Ariz.

From St. Joseph’s Hospital and the Palo Alto Medical Foundation/Sutter Health.

Received for publication June 12, 2018; accepted December 7, 2018.

Disclosure:Dr. Menick receives royalties from the referenced book Aesthetic Nasal Reconstruction: Principles and Practice. The remaining authors have no financial interest to declare in relation to the content of this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

Arthur H. Salibian, M.D., 1310 Stewart Drive, Suite 211, Orange, Calif. 92868,

Copyright © 2019 by the American Society of Plastic Surgeons