Reply: Simplifying the Forehead Flap for Nasal Reconstruction

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I thank the authors for their interest in our article, “Simplifying the Forehead Flap for Nasal Reconstruction: A Review of 420 Consecutive Cases,”1 and would like to comment on their most excellent and insightful observations. Agreed, the use of preoperative tissue expansion is exceedingly useful to both enhance forehead flap design and reduce donor-site morbidity. We are actively considering its use in more patients moving forward, in recognition of its utility.
The difference in the use of ear cartilage versus costal cartilage can be partially explained by patient and defect referral type, in addition to surgeon preference. Many of our referred cases for nasal reconstruction are smaller defects, and these often do not require large cartilage grafts for reconstruction per se, but rather smaller grafts, the majority along the alar rim in a nonanatomical location to prevent late alar retraction. In addition, the typical Caucasian male nose with significant solar damage may differ from Drs. Lu and Fan’s patient population, as these patients often have such inherent soft-tissue rigidity that large cartilage grafts are not required to prevent late tissue retraction, but we are in total agreement that there is no substitute for the robustness and sheer volume available from costal cartilage grafts. Again, we thank the authors very much for their interest in our article and we look forward to sharing cooperative work with them in the future.
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