Versatility of a microsurgical free-tissue transfer from the forearm in treating the difficult nose.

Ten selected patients with nasal defects in the covering, lining, or framework were treated by a vascularized free-tissue transfer from the forearm. A vascularized skin flap, fascia, and split radius were transferred in accordance with the shape of the defects. All flaps "took" perfectly, and satisfactory results were obtained. The grafted bones were stable over a follow-up period ranging from 1 to 6 years; however, some problems did arise in the course of treatment, including poor matches between the flap and surrounding facial skin, postoperative drooping of the flap used in the lining, and conspicuous donor sites. However, despite these drawbacks, microvascular free-tissue transfer from the forearm has proven to be a good choice for the restoration of a nose that is difficult to reconstruct by more conventional methods.