July 2019 #PRSJournalClub Wrap-Up: Microvascular Reconstruction of the Nose

by Marten Basta, MD
Plastic Surgery Resident
Brown University, Providence, RI


The July edition of #PRSJournalClub provided an excellent discussion of an important topic in Plastic Surgery in the PRS article entitled “Microvascular Reconstruction of the Nose with the Radial Forearm Flap: A 17-Year Experience in 47 patients” by Salibian, Menick, and Talley.  This discussion can be found on the #PRSJournal Facebook page, which enables a broad audience to ask questions and interact directly with the authors. The full article can be found here.

In this study, the authors present a 17-year personal experience with reconstruction of total or near-total nasal defects utilizing a staged approach.  In the first stage, a microvascular radial forearm fasciocutaneous flap is used to resurface the nasal soft tissue defect aided with a primary dorsal cartilage graft. The focus of this article is on the first stage of reconstruction, while later publications are planned to discuss tip reconstruction/refinement and further sculpting procedures. These defects are incredibly complex, requiring reconstruction of skin, cartilaginous support, and nasal lining. The radial forearm flap is folded on itself as needed to reconstruct the columellar soft tissue as well as the nasal floor lining. Microvascular anastomosis are typically done end-to-side to recipient external carotid artery (or branches thereof) and the internal jugular vein.  In this study, 47 patients underwent reconstruction from 2000-2017, most commonly for oncologic defect reconstruction or defects due to cocaine use. The majority of patients presented with anticipated total or subtotal nasal defects.  With an average follow up of 6 years, major complications occurred in 5 patients (3 – total flap loss, 2 – unplanned OR takeback). The authors report that otherwise, overall patient satisfaction was high and nostril opening size was very good. The authors should be commended for this wonderful article that truly reflects the complexity and high skill-demand of our more challenging patients.

The article was first discussed by the current Resident Ambassadors to the PRS Editorial Board Lily Mundy, MD, Rajiv Parikh, MD, and Kyle Sanniec, MD, and the special guest moderator Peter Taub, MD. Listen to the podcast discussion below:

In addition, Dr. Rod Rohrich discussed this article as a #PRSJournal Hot Topic in an exciting video discussion, which can be watched here:

An engaging and thought-provoking online discussion also took place on the #PRSJournal Facebook page over a two-day period (July 20th-21st), where established plastic surgeons and residents were able to ask questions and get answers from the authors of the article themselves! Don’t worry if you missed it! A summary of the interesting discussion is provided below.

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook!

Sincerely,

Marten Basta

This July #PRSJournalClub article (as well as other Journal Club selections from July), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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