Publication:

Complex nasal reconstruction using first dorsal metacarpal artery free flap: a case report

The columella is a key structure for nasal aesthetics and function. Its reconstruction poses a surgical challenge due to limited access, the need for structural support, and the requirement for a precise match in skin color and thickness. The kite flap, supplied by the first dorsal metacarpal artery (FDMA), has proven useful in various facial defects; however, its application in columellar reconstruction remains scarcely documented. We report a 31-year-old woman who developed complete columellar necrosis secondary to an untreated post-traumatic septal hematoma. Clinical examination revealed total absence of the columella, including soft-tissue coverage and cartilaginous support. A two-stage nasal reconstruction was performed using a free FDMA (kite) flap combined with a costal cartilage graft. The postoperative course was favorable, with no vascular complications and complete flap integration. Donor-site healing was satisfactory. Objective measurements demonstrated improvement of the nasolabial angle from 70° preoperatively to 95° postoperatively, and an increase in columellar projection from 1.2 mm to 4.8 mm. These findings reflect successful restoration of nasal contour and structural support. The FDMA Kite flap is a reliable and aesthetically suitable microsurgical option for columellar reconstruction in cases of severe tissue loss. Its thinness, dependable vascularity, and low donor-site morbidity make it a valuable tool for complex nasal reconstruction.