Nasal Reconstruction: Menick’s Technique

Abstract: Reconstructing nasal defects poses a significant challenge for plastic surgeons. Various techniques have been proposed in the literature, but none have consistently yielded optimal aesthetic results. This article presents the case of a patient with a transfixing nasal defect successfully reconstructed using the three-stage forehead flap technique, as practiced at the Department of Reconstructive and Plastic Surgery at Ibn Sina Hospital in Rabat. Keywords: Nasal defect, nasal reconstruction, forehead flap. Introduction Nasal reconstruction has historically been a fundamental aspect of plastic surgery, with the forehead flap being the cornerstone technique for repair [5]. Due to its superior color and texture match, the forehead serves as an ideal donor site for nasal resurfacing. However, forehead flaps, regardless of their vascular pedicle, tend to be thicker than native nasal skin. Traditionally, forehead flaps are transferred in two stages. In the first stage, the frontalis muscle and subcutaneous tissue are partially excised distally, and the flap is inset into the recipient site. Three weeks later, in the second stage, the pedicle is divided. However, this approach has limitations, including incomplete flap thinning and the risk of necrosis, particularly in smokers and complex nasal reconstructions. To address these issues, an additional surgical stage has been incorporated between flap transfer and pedicle division [2].