Total nasal reconstruction is a challenge for facial plastic surgeons. Although most cases can be handled with local flaps, a bad state of the perinasal soft tissues, such as patients with head and neck radiotherapy may preclude its use with vascular free-flaps being necessary. Radial forearm free flap has been the workhorse for nasal reconstruction in recent years. Its safety, ease of dissection and versatility has made it the favourite for nasal reconstruction. The downsides to this flap are the presence of hair and the visible scar in the donor site. The folded ulnar forearm flap described by the authors is as versatile as the folded radial forearm flap for total nasal reconstruction, also providing hair-free skin with a superior donor-site cosmesis. The tubular folding creates a vascular envelope amenable to same-stage framework reconstruction; additional refinement procedures were needed. The flap was used in 10 patients with total or subtotal nasal defects as a multi-staged procedure with a good outcome and a low complication rate. A great paper on facial reconstruction. 

The folded ulnar forearm flap for nasal reconstruction.
Hsiao YC, Huang JJ, Zelken JA, et al.
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Eduardo Morera Serna

Hospital Universitario Son Espases, Palma de Mallorca, Spain.

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