An Innovative Preauricular Free Flap Pedicled with Retrograde Vascular for Pediatric Nasal Reconstruction.

SUMMARY: Nasal reconstruction in pediatric patients is challenging and requires consideration of later nasal development. The authors introduce an innovative preauricular free flap pedicled with retrograde vascular (PFFPRV) for pediatric nasal reconstruction. In the PFFPRV technique, the retrograde superficial temporal vessels were used as the flap pedicle. The lateral alar artery and angular vein were used as vessels of the nasal recipient zone. The flap vessels were anastomosed directly to the recipient area vessels without additional vessel transplantation. Eight pediatric patients with nasal defects underwent this operation. All patients were followed up for more than 2 years. Medical history data were retrospectively analyzed. Preoperative and postoperative facial photographs were compared and analyzed. Satisfaction of the patients' parents with the aesthetic results was assessed. All patients were successfully operated on without intraoperative complications. None of the procedures required additional blood vessel grafts. One patient developed a vascular crisis the day after surgery and underwent vascular exploration. The free flaps of all patients survived without wound infection or necrosis. The color difference of the flap gradually became non-obvious. The transplanted flap did not show obvious contracture or retraction, and the nose was symmetric and developed well. The parents of all patients were satisfied with the surgical results. The authors think this PFFPRV technique can be a reasonable alternative strategy for reconstruction of pediatric nasal defects, with no adverse effects on nasal development and no need for vascular transplantation.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.