Reconstruction of the Burned Nose Using an Expanded Skin-Grafted Forehead Flap, Delayed Turnover Flaps, and Indocyanine Green Perfusion Assessment.

Reconstruction of the burned nose is challenging because defects may involve external skin, internal lining, and structural support within scarred or previously grafted tissues. We report the case of a 35-year-old man who sustained an approximately 20% total body surface area flame burn involving the face, neck, chest, and upper extremities, requiring acute excision and split-thickness skin grafting. He later developed a severe postburn nasal deformity with loss of the lower third of the nose, airway compromise, and deficiency of lining, support, and external soft tissue. Both the forehead and nasal dorsum had previously been resurfaced with split-thickness skin grafts, limiting standard reconstructive options. A staged reconstruction was performed using tissue expansion of the grafted forehead, delayed bipedicled turnover flaps from grafted dorsal nasal skin for internal lining, costal cartilage grafting for structural support, and a paramedian forehead flap for external coverage. Intraoperative indocyanine green fluorescence angiography was used to assess perfusion and guide operative decision-making. The reconstruction restored nasal contour and airway patency without flap loss, infection, or major complication, and avoided microsurgical free tissue transfer. At long-term follow-up extending to 10 years from the initial injury, the reconstruction remained stable. This case demonstrates that previously grafted tissue can be recruited for complex nasal reconstruction when augmented by tissue expansion, staged delay, and intraoperative perfusion assessment.