A 73-year-old man with recurrent squamous cell carcinoma spreading to the nasal septum, dorsum, and lymph nodes (cT4aN2bM0) previously underwent partial rhinectomy and left forehead flap repair at another center. He later had partial rhinectomy and bilateral neck dissection, diagnosed as pN3b with extranodal extension (ENE+), and had a tissue expander placed sub-galeally on the right forehead due to prior scars.
After radiotherapy with adjuvant treatment, reconstruction was delayed six months post-radiation. During this time, the columella progressively deformed, slanting to the left. The plan was to reconstruct the entire nasal skin using a forehead flap attached to the remaining columella via an open rhinoplasty-type incision. The goal agreed with the patient was to restore the nose’s appearance as naturally as possible, using computer-aided design for accurate contouring and measurements.
After mapping the right supratrochlear artery with ultrasound, the flap was designed accordingly on the forehead. Local hinge flaps from the cheeks were planned to reconstruct the nasal lining.
