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A 54-year-old woman with extensive midfacial destruction after 15 years of cocaine abuse underwent total nasal reconstruction using a medial femoral condyle free flap for internal lining and bone support combined with a paramedian forehead flap for external coverage. Long-term functional and aesthetic outcomes were satisfactory with minimal donor-site morbidity.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/medial-femoral-condyle-flap-for-nasal-support-in-cocaine-induced-midline-destruction-case-report/408737/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/medial-femoral-condyle-flap-for-nasal-support-in-cocaine-induced-midline-destruction-case-report/408737.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What condition does the report address?","Question",{"text":113,"@type":114},"The report addresses cocaine-induced midline destructive lesions resulting from prolonged cocaine abuse, which can damage midface osteocartilaginous structures including the nose, sinuses, and palate.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What reconstructive approach was used for total nasal reconstruction?",{"text":118,"@type":114},"Total nasal reconstruction used a medial femoral condyle free flap (MFCFF) for internal lining and bone support, combined with a paramedian forehead flap for external coverage.",{"name":120,"@type":111,"acceptedAnswer":121},"Why was a two-stage reconstruction chosen?",{"text":122,"@type":114},"A two-stage reconstruction was adopted to accommodate the patient’s anxiety and to allow direct monitoring of the MFCFF before definitive external coverage.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},408737,1791096256,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Article published online: 2025-05-13  \nCase Report 463  \nMedial Femoral Condyle Flap for Nasal Support in Cocaine-Induced Midline Destruction  \nPedro Alvedro-Ruiz 1 Belén Andresen-Lorca 1 Iván Heredia-Alcalde 1 Alessandro Thione 1  \nMaría Dolores Pérez-del-Caz 1 Alberto Pérez-García 1  \n1 Department of Plastic and Reconstructive Surgery, University and Polytechnic Hospital La Fe, Valencia, Spain  \nIndian J Plast Surg 2025;58:463–467.  \nAddress for correspondence Alvedro-Ruiz Pedro, MD, Department of Plastic and Reconstructive Surgery, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell, 106, Valencia 46026, Spain (e-mail: [pedroalvedroruiz@gmail.com](pedroalvedroruiz@gmail.com)).  \nAbstract  \nKeywords  \n► medial femoral condyle flap  \n► nasal reconstruction  \n► cocaine  \nProlonged cocaine use can severely damage the osteocartilaginous structures of the midface region. Involvement of the nose, sinuses, and palate has been grouped into a syndrome called cocaine-induced midline destructive lesions. These lesions may resemble other necrotizing conditions, often complicating diagnosis and treatment. A complex nasal reconstruction is introduced in a 54-year-old woman with extensive midfacial destruction after 15 years of cocaine abuse. Total nasal reconstruction was performed using a medial femoral condyle free flap (MFCFF) for internal lining and bone support in combination with a paramedian forehead flap for external coverage. The MFCFF proved to be effective in recreating the anatomy of the nasal dorsum with minimal donor site morbidity, while the paramedian forehead flap improved the aesthetic results. Despite the need for multiple surgical interventions, this approach showed satisfactory functional and aesthetic long-term results.  \nIntroduction  \nLong-term cocaine abuse can result in progressive damage of the osteocartilaginous structures of the midface region. Destruction of nasal structures, sinuses, and palate has been grouped into a syndrome called cocaine-induced midline destructive lesions (CIMDLs).1 These mutilating lesions may mimic other necrotizing midfacial lesions such as Wegener’s granulomatosis, chronic infections, or lymphoproliferative diseases.2  \nNasal reconstruction is complex and requires an individual approach. While minor defects can be reconstructed with local flaps or composite grafts, free flaps are the most common choice for reconstruction of full-thickness defects that necessitate replacement of all layers. Several free flapshave been historically proposed, with free radial forearm free flap (RFFF) being the most commonly used. The aim of this report was to introduce a total nasal reconstruction after cocaine abuse with a medial femoral condyle free flap (MFCFF) and a paramedian forehead flap.  \narticle published online May 13, 2025  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1809054 . ISSN 0970-0358.  \nCase Report  \nA 54-year-old female was referred to our institution for nasal reconstruction evaluation. She had been taking cocaine intranasally over the past 15 years. Consequently, she exhibited extensive osteonecrosis and midface soft tissue destruction. Physical examination showed a soft tissue collapse due to the loss of the underlying bone support, with an associated nasal fistula ( ►Fig. 1). Computerized tomography (CT) scan revealed destruction ofnasal structures, ethmoidal bones, maxillary and sphenoid sinuses, hard palate, and medial wall of both orbits ( ►Fig. 2). Prior to planning any reconstructive procedure, a 24-month period of abstinence from cocaine was required. A decision was made to replace the internal lining and bone support withaMFCFFand tousea paramedian foreheadflap for external coverage. A two-stage reconstruction was adopted because the patient suffered from anxiety and we feared she would experience difficulties with positional instructions during the postoperative period, so we wanted to monitor the MFCFF by direct visual exami","cbCaid2tRUl6yGeu","https://ap.wps.com/l/cbCaid2tRUl6yGeu","pdf",4031236,"English","# Introduction\n# Case Report\n## Preoperative assessment and planning\n## Two-stage reconstruction and outcomes\n# Discussion","[{\"question\":\"What condition does the report address?\",\"answer\":\"The report addresses cocaine-induced midline destructive lesions resulting from prolonged cocaine abuse, which can damage midface osteocartilaginous structures including the nose, sinuses, and palate.\"},{\"question\":\"What reconstructive approach was used for total nasal reconstruction?\",\"answer\":\"Total nasal reconstruction used a medial femoral condyle free flap (MFCFF) for internal lining and bone support, combined with a paramedian forehead flap for external coverage.\"},{\"question\":\"Why was a two-stage reconstruction chosen?\",\"answer\":\"A two-stage reconstruction was adopted to accommodate the patient’s anxiety and to allow direct monitoring of the MFCFF before definitive external coverage.\"}]","Medial Femoral Condyle Flap for Nasal Support in Cocaine-Induced Midline Destruction - Case Report | PDF",1790580381,13]