Done by: Dr.Al-Siaghi Yahya Ahmed PHD first consul. Plastic surgeon / Al-Ajaly Mohaned Yahia senior specialist

General surgery

nasal reconstruction was major challenge especialy large nasal defects for any cause history of nasal reconstruction first described 2600 years ago in india ,many modification for nasal reconstruction was developed from time to time one of this modifications is converse scalping flap {axial pattern flap}…..scalping flap has valuable method for providing tissue for nasal reconstruction since 1942 after second world war.

Blood supply of scalping flap

• primary blood supply :- superficial temporal artery
• secondary blood supply:- supra orbital and supra trochlear branch of ophthalmic artery

Techniques

• The procedure for scalping flap was undergoing in tow stages and some times threestage
• First stage :-reconstruction of nose by (scalp flap),and skeletal support by(bone or cartilage)
• ECOND STAGE :-we do this procedure after 3 weeks after the first stage for till good neovascularization of flap ,,,we do seperation of flap and repositioninig of scalp to primary site and grafting of forehead defect with skin graft
• THIRD STAGE :-we do this procedure in some patient about 6month post operative if there was still bulking tissue for reduction in size of the nose.

Advantage

Reliable flap,Robust flap,Provide large amount of tissue for nasal reconstruction,,Colour and texture and thickness of forhead skin similar to nasal skin,,Reshaping of nose can be done with skeletal support,,Avoid centrally scarring of forehead with scarring hidden in scalp.

Case studies

From period of 2017 to 2019 we do ( 8) cases for reconstruction of the nose by converse scalping flap , (4 ) cases post trauma,(3) cases with nasal malignancy,(1) case post infection (leishmaniasis) give us good result functionaly and aesthetically for nasal reconstruction ,,,one of the cases.

Conclusion

For large nasal defect either total or sub total ,converse flap was safer and less disfiguring flap than another,,,,so converse scalping flap remain attractive option in nose reconstruction And is madndatory for all plastic surgeon to put in decision method of converse scalping flap in difficult cases for major destruction of nose because of good outcome of procedure functionally and aestheticaly.