Strategies to increase flap survival in nasal reconstruction in patients with deep panfacial burns.

Total nasal reconstruction requires the management of skin, cartilage, and nasal mucosa. This three-dimensional surgical approach is especially restricted in patients with severe deformities after deep panfacial burns. In this regard, the development of tissue fibrosis reduces the quality and reliability of surrounded donor sites, limiting the surgical options and flap survival outcomes. This report discusses the benefit of tissue protection procedures, such as flap delay and leech therapy, in the total nasal reconstruction of a patient with split-thickness skin grafts on donor sites for forehead and nasolabial flaps.