Approach to Reconstruction of Nasal Defects

Abstract

The nose is the most central and anterior projecting facial feature. Therefore, the presence of a defect is easily noticeable to the untrained eye. Return of the defect to the original form is an achievable end goal of reconstruction, necessitating appropriate reformation of three-dimensional geometry, proper establishment of symmetry, and excellent color and texture match to the adjacent structures. Regarding its physiological importance, disruption of the normal function may cause respiratory obstruction and contribute to patient distress. To achieve successful repair, preoperative preparation must consider the location, the layers involved, and the size of the defect. Prompt and well-organized repair minimizes the occurrence of progressive necrosis and severe late-stage deformity. Here the authors provide a framework to approach various nasal defects and provide a review of the novel ideologies and techniques. The workhorse of nasal repair, the forehead flap, is discussed independently due to the breadth of innovation.

Aesthetic Outcomes of the Adipofascial Turnover Flap for Nasal Defects

“…Diligent wound care is required to control drainage from the raw surface of the flap, and patients are subjected to the psychosocial effects of this temporary aesthetic deformity. 4 The forehead flap is additionally associated with visible scarring of the forehead, potential brow elevation, and recipient site hair growth. 1 , 9 In contrast, the adipofascial flap avoids these potential drawbacks of the forehead flap.…”

“…In addition to the increased costs associated with staged procedures and visible donor site scar, patients also must accept a period of discomfort, disfigurement, and wound care that accompanies the interval between the original procedure and the final division and inset. 4 The single-stage adipofascial turnover flap with full-thickness skin grafting is a novel technique that has previously been demonstrated as a safe, reliable, and cost-effective alternative for nasal tip reconstruction. 5 The purpose of this study was to compare aesthetic outcomes of these two reconstructive techniques.…”

Reconstruction of the Nose: Management of Nasal Cutaneous Defects According to Aesthetic Subunit and Defect Size. A Review

“…In patients with thin skin that refuse a PFF reconstruction, we recommend the reconstruction with a nasolabial folded flap in two stages. It has been advocated that the technique of folding a flap on itself should not be used in the internal nasal valve and nostril region because tissue bulk can obstruct the airway [10]. On the other hand, this technique provides consistent vascular supply, enables a single flap harvest with minimal social segregation, and avoids forehead scars; we perform the nasolabial folded flap in patients with thin cheek skin to reconstruct the whole ala, achieving good functional and aesthetic results (Figure 9).…”

“…Nasal defects can involve the skin, cartilage, and bone, or the internal mucosal lining, in various degrees, and even the smallest loss of substance can create aesthetic and psychosocial concerns for patients. Therefore, surgeons who perform nasal reconstruction should be strictly confident with the pertinent surgical anatomy in order to tailor the procedure to the patient's needs [10].…”

Refinements of the application of paramedian forehead flap in nasal defects repair in Asian patients

“…The nose is an important facial aesthetic unit with an anatomically distinct and delicate structure compared to the forehead and cheeks . Partial‐ or full‐thickness defects of nose can be caused by trauma, excision of benign or malignant tumors, vascular embolization, etc And nasal defect can affect both the appearance and respiratory function of the patient . Reconstruction of nasal defects has been a significant challenge for plastic surgeons since ancient times.…”