We read with interest the article on practical details of nasal reconstruction by Dr. Menick.1 However, we have some different opinions on the treatment strategy. The patient was injected with hyaluronic acid filler, which later caused necrosis of her nose, upper lip, and cheek. Because the filler presumably thrombosed the lateral nasal branch of the right angular artery, the supratrochlear artery on the same side could also be partly involved by means of the anastomotic branches. For that reason, we consider that the contralateral paramedian forehead flap was probably a safer choice as the donor site in this case.
We also noticed that the author cut the excess skin of the distal margin of the cover flap in the intermediate operation (stage 2). The template of contralateral ala was used to design the exact margin of the reconstructed alar rim. To some extent, it is a good way of precisely determining the exact size of the cover flap. However, we have reserved judgment of this “overprecise” manner in the early stage of nasal reconstruction. The extent of flap contracture could not be estimated until 1- to 2-year follow-up. The flap could achieve a stable condition after a relatively long recovery period. In our opinion, the best timing for the final excision of the excess skin is 1 to 2 years after pedicle division (stage 3), because the revision (stage 4) is probably inevitable.
The authors have no financial interest to declare in relation to the content of this communication.
Jianjun You, M.D.
Sheng Wang, M.D.
Huan Wang, M.D.
Fei Fan, M.D.
Plastic Surgery Hospital
Chinese Academy of Medical Sciences
Peking Union Medical College
Beijing, People’s Republic of China
1. Menick FJ. Practical details of nasal reconstruction. Plast Reconstr Surg. 2013;131:613e–630e
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