PMC5469245_01
Nasal columella defect associated with a large, contiguous septal perforation after cocaine-induced nose destruction, in a 32-year-old male patient. Nasal tip projection was preserved. (a) Cosmetic result six months after columella reconstruction with a philtrum-based skin flap. (b) Aesthetic outcome two years after surgical reconstruction in profile (c) and worm's-eye view (d) Tip projection is preserved; no upper lip protrusion is noticeable
IJPS-50-96-g001.jpg
PMC5469245_01_IJPS-50-96-g001.jpg
F1
Nasal tip projection was still maintained, although the substantial absence of columella support [Figure 1a]. Cosmetic result was considered satisfactory by both patient and surgeon [Figure 1b-d].
Preoperative cosmetic result with columellar prosthesis on
IJPS-50-96-g002.jpg
PMC5469245_01_IJPS-50-96-g002.jpg
F2
He was using prosthesis to hide the defect with acceptable cosmetic results [Figure 2].
Drawing of the incision lines used to harvest the inferiorly based philtral advancement flap with the two Burrow's triangles excised laterally to the designed flap
IJPS-50-96-g003.jpg
PMC5469245_01_IJPS-50-96-g003.jpg
F3
Laterally to the designed flap, we defined and removed two small Burrow's triangles to advance the skin flap [Figures 3 and 4a].
Intraoperative view. Two Burrow's triangles were excised laterally to the designed advancement flap (continuous arrows). A 1 cm x 1 cm philtrum-based advancement skin flap was defined. An anterosuperiorly based random mucosal flap dissected from the mucosa covering the remaining portion of the columellar septum was harvested (dotted arrow). (a) The philtral flap is folded together with the mucosal flap in a tubular structure to reconstruct posterior aspect of columella; anterior margin of the skin flap was then sutured to the remaining portion of columellar skin (b)
IJPS-50-96-g004.jpg
PMC5469245_01_IJPS-50-96-g004.jpg
F4
Laterally to the designed flap, we defined and removed two small Burrow's triangles to advance the skin flap [Figures 3 and 4a]. An anterosuperiorly based random mucosal flap dissected from the mucosa covering the remaining portion of columellar septum (the anterior margin of septal perforation) was harvested to complete superiorly the hemi-tubular structure created with the skin flap [Figure 4a]. Anterior margin of the skin flap was sutured to the remaining portion of columellar skin [Figure 4b].