(A617) Resurfacing Endoscopic Free Flap for Hereditary Hemorrhagic Telangiectasia

Introduction: Epistaxis related to hereditary hemorrhagic telangiectasia (HHT) decreases quality of life (QoL) and can be life-threatening. Current medical and surgical options are limited, particularly in the advanced stages of the disease. Nasal closure may be offered in the setting of failed septodermoplasty, with sacrifice of the nasal airway. We present a novel procedure performed on a patient with severe HHT-related epistaxis who failed medical therapy and septodermoplasty.

Methods: This case report describes a 68-year-old man with severe, life-threatening HHT-related recurrent epistaxis who had exhausted available medical and surgical treatments but declined nasal closure. He underwent nasal cavity resurfacing with an endoscopically placed radial forearm free flap (REFF) using a minimally invasive technique with a small cervical incision for microvascular anastomosis and a Caldwell-Luc antrostomy for delivery of the flap into the nasal cavity. Resection of nasal structures and stripping of nasal mucosa was performed with routine endoscopic sinus instruments and techniques. Inset of the flap and placement of nasal packing to maintain flap position was also performed endoscopically. Impact on QoL, nasal function, and impact on epistaxis were all assessed at one-year post-surgery.

Results: The flap remained viable postoperatively without any immediate surgical complications. There was a significant decrease in the frequency and severity of epistaxis. There was maintenance of nasal function and improved QoL at one-year status post REFF.

Conclusions: REFF is a safe and effective procedure for management of HHT-related recurrent epistaxis refractory to available treatments in patients who decline nasal closure. The procedure may be considered a potential replacement to nasal closure as it has the advantage of maintaining nasal function while still offering a significant decrease in epistaxis and a significant improvement in QoL.