Filtrum Advancement Flap for Columellar Reconstruction: A Case Report of Columellar Skin Necrosis Following Secondary Rhinoseptoplasty

Abstract

Columella reconstruction is challenging due to the scarcity of adjacent tissue and limited blood supply. Several flaps have been described for this reconstruction, including nasolabial, forehead, nasofacial, and subnasal flaps. We present the case of a 29-year-old female with columellar skin necrosis following secondary rhinoseptoplasty. Despite attempts to improve oxygenation with hyperbaric oxygen therapy, the patient developed total columellar skin necrosis. Reconstruction was performed using a philtrum advancement flap. Eleven millimeters of necrotic tissue were resected, and an 11×11 mm flap from the philtrum, irrigated by branches of the superior labial arteries, was raised. The flap was folded into a hemicylindrical structure to cover the defect, achieving satisfactory reconstruction. The patient recovered without complications, with positive aesthetic and functional results at six months. The philtrum advancement flap is an effective and aesthetic technique for columella reconstruction and should be considered by otolaryngologists in their surgical techniques.