The Bilateral Trans Alar Forehead Flap to Reconstruct the Cocaine Nose: A Case Report

Isolated circumferential lining contraction of the midvault and nasal floor is a challenging reconstructive problem. In the cocaine nose, extensive loss of mucosal lining, with or without loss of columella, will result in collapse of the nose into the pyriform fossa. Various techniques have been used to provide nasal lining, but when the defect is extensive a free tissue transfer is advocated. The forehead flap is not able to reach the nasal vestibule when the nasal skin is intact. Transecting the ala creates a shortcut route for the forehead flap to provide lining for the nasal vault, nasal floor, and soft tissue cover for the columella. A bilateral trans alar forehead flap was used to reconstruct the nasal lining and columella in a patient with a severely contracted cocaine nose. An L strut cartilage graft was covered with the forehead flaps, which were divided and inset in the nasal vault separately 3 weeks apart. The bilateral trans alar forehead flap is an excellent alternative to microsurgical reconstruction of the nasal lining and columella in the cocaine nose. Secondary thinning of a wide columella may be indicated, but the forehead skin provides a good color match. The scars on the forehead and the alar scars on the border of subunits of the nose heal well and are minor tradeoffs.