Reconstruction of Complex Nasal Defect With Anterolateral Thigh Chimeric Flap

Total nasal defects, including adjacent soft tissue damage, present a challenge for plastic surgeons, and in this case, free flaps should be an alternative when local flaps are limited. However, the importance of donor site morbidity must be taken into account for free flaps. Due to flap bulkiness, the anterolateral thigh (ALT) free flaps are less commonly used to restore nasal structures. Our case used a thinned ALT flap to reconstruct the entire nasal defect and part of the upper lip due to the resection of poorly differentiated squamous cell carcinoma. Two ALT flaps were harvested to reconstruct a 10 × 6 cm defect spanning the entire nose and part of the upper lip. Both skin paddles were thinned to a minimum of 4 mm thickness. A costal cartilage graft was used to create a framework for structural support. The donor site was closed with local flaps and skin grafts. No complications were noted during follow-ups. After 24 months, the patient had an excellent nasal contour that matched her skin tone and had no airway obstruction. The thinned ALT chimeric flap can be ideal for large defects composed of multiple anatomical units, even in the facial region. Its advantages are that it is thin, flexible, and well vascularized and can provide favorable aesthetic results with minimal donor site morbidity.