Septo-columellar reconstruction with radial forearm free flap

INTRODUCTION: Columellar subunit reconstruction is described as one the most challenging area in the literature. Radial forearm free flap (RFFF) can easily provide the reconstruction of columella and neighbouring regions with different styles of designs and different types of tissues included if needed.
METHODS: Patients who have large composite defects in the septocolumellar region and have been reconstructed with RFFF between 2018-2021 were included in the study. Patients' age, gender, etiology of septocolumellar defect, anatomical deficiencies on nose, flap sizes and designs, cartilage donor site, recipient vessels, flap donor site repair methods, time of hospital stay, and complications were investigated.
RESULTS: Six patients, comprising five males and one female with an average age of 50.8 years, were evaluated. The etiologies were congenital agenesis in one patient, trauma in two patients, and tumors in three patients. Adipofascial radial forearm free flaps (RFFF) were utilized in two patients, with primary closure of the donor sites. To prevent excessive skin thickness in septal mucosal reconstruction, only adipofascial flaps were employed. The facial artery and vein served as the recipient vessels in all cases, with the pedicle tunneled from the nasal region to the submandibular region. The average flap size was 5.08 x 4.66 cm. Septal cartilage was used to create the cartilage framework in two cases, while costal cartilage was used in the remaining cases. The mean operation time was 6.6 hours, the average ICU stay was 16.3 hours, and the mean hospitalization duration was 6.5 days. Complications included scar spread and synechia at the flap donor site in two different patients.
DISCUSSION AND CONCLUSION: Using the facial artery and vein for recipient vessels makes the new skin scarring away from midface area. RFFF provides an excellent option for optimal septocolumellar reconstruction deriving from a variety of etiologies with the disadvantage of sacrificing a main artery in upper extremity.