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October 1995

The Epithelial 'Turn-in' Flap in Nasal Reconstruction

Author Affiliations

From the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Oregon Health Sciences University, Portland. Dr Park is currently with the Department of Otolaryngology—Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville.

Arch Otolaryngol Head Neck Surg. 1995;121(10):1122-1127. doi:10.1001/archotol.1995.01890100036006

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 followup 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 reconstitution 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.(Arch Otolaryngol Head Neck Surg. 1995;121:1122-1127)