Total Nasal Reconstruction Redefined: Classic Craft Meets Microsurgical Innovation

The authors illustrate a unique case of total nasal reconstruction that successfully combined historical reconstructive techniques with modern microsurgery, supported by artificial intelligence-assisted operative planning. The patient presented with multiple failed nasal reconstructions, previously performed at different surgical units, aimed to correct congenital nasal dysplasia due to Binder syndrome. In this case, a prelaminated radial forearm free flap was used for the nasal lining, a costal cartilage tripod for structural support, and a delayed forehead flap for external coverage. To reconstruct the nasal septum and ensure an anatomically aligned airway, the authors employed a vascularised corticocancellous free flap from the medial femoral condyle. Fourteen months postoperatively, the patient had a well-healed, mucosalised airway and an improved nasal structure.