A Novel T-Shaped Design of the Forehead Flap in Columella Reconstruction: T-Shaped Design of the Forehead Flap.

Abstract

Reconstruction of the columella is challenging because of its unique contours, narrow horizontal dimension, paucity of adjacent soft tissues, and tenuous vascularity. For larger defects or defects with poor outcomes after composite graft or local flap reconstruction, forehead flaps have been used due to their robust blood supply and sufficient tissue. However, we found an increased risk of flap dehiscence between the forehead flap and the upper lip since the connection is only approximately 0.5-cm wide.In this series, we proposed a novel modification of a T-shaped forehead flap in columella reconstruction. We created a subcutaneous pocket and inserted the distal de-epithelialized part of the flap into the pocket to obtain greater connection and contact between the two tissues. Between February 2017 and June 2023, 23 patients were treated with our proposed surgical method. The mean follow-up time was 34.5 months (range, 7 months to 80 months). All uneven wounds healed uneventfully within 2 weeks. No disruption of the columellar edge or other complications were noted. Our novel T-shaped design for columella reconstruction is a safe, straightforward, and reliable technique. The method is technically simple and has a low learning curve. This approach may decrease the risk of flap disruption in columella reconstruction and yield a superior aesthetic result, with which patients are satisfied.