The epithelial 'turn-in' flap in nasal reconstruction.

OBJECTIVES

To evaluate the epithelial "turn-in" flap for reconstruction of the internal lining in full-thickness nasal defects. Highlighted are its indications, technique, complications, and clinical success, particularly in comparison with the other common modalities for reconstructing this nasal lining. Also, to determine how the random flap withstands vigorous thinning.

DESIGN

A retrospective chart review and clinical follow-up of all patients with full-thickness nasal defects of the nose.

SETTING

The patient pool comes from a tertiary care center that draws from a large geographic area in the Northwest. Both urban and rural demographics are represented.

PATIENTS

Fifty-six patients with large full-thickness nasal defects were reviewed, 18 of which were reconstructed with the epithelial turn-in flap. The causes of the original defect were varied.

INTERVENTION

Full-thickness nasal defects were reconstructed in a layered fashion. The turn-in flaps were aggressively thinned to the subdermal plane to minimize flap bulk and airway compromise.

MAIN OUTCOME MEASURES

Attention was made to the size and precise location of the defect, the mode of reconstruction, flap viability, and nasal function.

RESULTS

Eighteen patients had turn-in flaps for reconstruction of the internal lining. Sixteen patients (89%) had 100% viability of their flaps. Seventeen (94%) reported normal nasal function.

CONCLUSIONS

The epithelial turn-in flap is a robust flap that provides dependable and functional results. One of the major advantages of this flap over other methods is that often there is no donor site morbidity. For many select defects, the turn-in flap remains a method of choice for repair of the internal lining.