The use of a periosteal/forehead flap with sandwiched conchal cartilage graft: A novel approach for nasal reconstruction in the absence of a nasal septum

Reconstruction of the nose following full-thickness resection of the nasal bones, septum, S and the overlying skin and the internal mucosa poses a challenge. The nasal septum normally provides the supportive framework for the nose, and when it is preserved, reconstruction of the rest of the nose is possible using a combination of a paramedian forehead flap, septal flaps, and/or free cartilage grafts. In the absence of the septum, subtotal or total nasal reconstruction is very difficult, and under these circumstances most workers use a prosthesis stabilized by osseointegration. In this report, we describe the use of a periosteal forehead flap to provide a vascular bed for bilateral conchal grafts that provided the structural scaffolding for a paramedian forehead flap. We have only used this technique in this patient. In this way, a blood supply was recruited for the conchal grafts in addition to providing an adequate intranasal lining.