Columella Reconstruction With Elbaz’s Flap: A Case Report And Litterature Review
L Ndiaye, A Sankale, A Ndiaye, L Foba
Keywords
columella reconstruction, edge nasal flap, elbaz
Citation
L Ndiaye, A Sankale, A Ndiaye, L Foba. Columella Reconstruction With Elbaz’s Flap: A Case Report And Litterature Review. The Internet Journal of Plastic Surgery. 2016 Volume 12 Number 1.
DOI: 10.5580/IJPS.36880
Abstract
Columella reconstruction remains a challenging problem for reconstructive surgeons. We report a28-year-old patient with complete columella defect following human bite, successfully reconstructed by an edge nasal flap according to Elbaz. No complications occurred and result was assessed as very good after two years follow up. Elbaz’s flap can be a good and safe option for columella reconstruction.
Introduction
The columella is one of the key elements of the aesthetic of the nose’s tip. Etiologies of columella loss of substance have different causes dominated by surgical tumor resection [1]. The columella has repeatedly proven to be one of the most complex nasal subunits to reconstruct and therefore has prompted several techniques to be published in literature [2, 3, 4]. Through this clinical case, we report a columella reconstruction by an edge nasal flap as described by Elbaz [5].
Case report
A 28-year-old manwas referred for columella loss of substance after a human bite. Clinical examination showed a complete defect of the columella with collapse and widening of the nostrils (figure 1). Columella reconstruction by Elbaz’s flap was therefore planed.Operative technique Surgical procedure was performed under general anesthesia. The flap was drown with a width of 3mm at the 2/3 proximal end of the nostril. A transfixing incision was made to the nostril edge. The flaps were elevated, pediculated on the tip,and the donor sites were closed primary. The mucosa of the nasal septum was incised vertically and decollated in each side of it. The nasal edge flaps were translated and sutured medially together in front of and behind in continuity of the septum (figures 2,3).A dressing was made with ointment and the stitches were removed at day 7.No complications occurred and the flaps survived completely. After two years follow up, cosmetic result was judged as good (figure 4).
Figure 1
Figure 2
Figure 3
Figure 4
Discussion
Columella defects are of diverse origin and those secondary to carcinomas resection are the main causeof the defect [1]. These etiologies are more represented in the elderly of white races. Specific etiologies can be noted such as sequelas of Cancrum oris and syphilis [6] as well as leprosy, especially in developing countries. Columella defect following human bite is very rare or even unique. It occurs in circumstances of brawl in young people as in most traumatic etiologies. The columella defects are rarely isolated and often associated with those of the lower third of the nose and or upper lip [7, 8]. Columella reconstruction is a difficult problem, because ofits three-dimensional aspect, located at the crossroads of the tip of the nose, the septum and the labial philtrum [9]. In the isolated defect repair must obey the law of the third [3]. For defect less than a third, composite graft of the helix can be realize [10,11], between two-thirds and one-third, repair notes of a local tummy by shreds of upper lip or wing flaps; beyond the two-thirds, the reconstruction by flaps initial for the skin recovery must be performed [1,7]. We opted in our case to perform reconstruction of total columella defect by an edge nasal flap as described by Elbaz [5]. Thisflap was chosen according to multiple reasons. Locally, the nostril was large in it’s transversally diameter allowing for removal of the nasal flap. The described technique left minimal scarring on the face.The tip of the nose is well shaped flap and in a few weeks good color adaptation with nasal skin occurred.The risk of hypertrophic scar in young people did not support a decision tomake a loco-regional flap. This technique has an advantage to be carried out in a surgery with little aesthetic involvement [5]. It is especially indicated in patients with broad nostrils like negroid types because it reduces the negroid shape and then improves the aesthetic of the nose [5].
Conclusion
Edge nasal flap is a good, safe, and reliable technique for columella repair. Reconstruction is made in a single surgery withminimal aesthetic requirement. It can be proposed as first consideration to reconstitute the columella in people with large nostrilsbecause it can provide sufficient tissue to replace total columella loss.