Nasal Reconstruction Based on Aesthetic Subunits in Orientals

Abstract

Reconstruction based on the aesthetic subunit principle has yielded good aesthetic outcomes in patients with moderate to severe nasal defects caused by trauma or tumor resection. However, the topographic subunits previously proposed are often unsuitable for Orientals. Compared with the nose in white patients, the nose in Orientals is low, lacks nasal muscle, and has a flat glabella; the structural features of the underlying cartilage and bone are not distinctly reflected in outward appearance. The authors devised aesthetic subunits suitable for Orientals, and they used these units to reconstruct various parts of the nose. The major difference between these units and those presented previously is the lack of soft triangles and the addition of the glabella as an independent unit. The authors divided the nose into the following five topographic units: the glabella, the nasal dorsum, the nasal tip, and the two alae. The border of the nasal dorsum unit was extended to above the maxillonasal suture. The basic reconstruction techniques use a V-Y advancement flap from the forehead to reconstruct the glabella, an island flap from the forehead to reconstruct the nasal dorsum and nasal tip, a nasolabial flap to reconstruct an ala, and a malar flap to reconstruct the cheek. A combination of flaps was used when the defect involved more than one unit. This concept was used for nasal reconstruction in 24 patients. In one patient undergoing reconstruction of the nasal dorsum and in one undergoing reconstruction of the nasal tip, the texture of the forearm flap did not match well, which resulted in a slightly unsatisfactory aesthetic outcome. In one patient in whom the glabella, nasal dorsum, and part of the cheek were reconstructed simultaneously, a web was formed at the medial ocular angle, and a secondary operation was subsequently performed using Z-plasty. In one patient undergoing reconstruction with a forehead flap, defatting was required to reduce the bulk of the subcutaneous flap pedicle at the glabella. However, suture lines were placed in the most inconspicuous sites in all patients, and the use of a trapdoor contraction emphasized the three-dimensional appearance of the nose. The use of these aesthetic subunits for reconstruction offers several advantages, particularly in Oriental patients. Because the nasal dorsum is reconstructed together with the side walls, tenting of the nasal dorsum is avoided, which prevents a flat appearance of the nose. A forehead flap is useful in the repair of complex defects. Defects of the alae should be separately reconstructed with a nasolabial flap to enhance the effect of the trapdoor contraction and to highlight the three-dimensional appearance of the nose. Candidates for reconstruction should be selected on the basis of nasal structure. The results suggest that these units can also be used in some white patients.

Use of distant V-Y plasty in reconstruction of defects on the nasal dorsum: A new modification of V-Y plasty

“…However, there is still debate about the ideal flap. For example, the forehead flap may require grafting of the donor area, it may lead to trapdoor contraction, it may cause congestion or necrosis, and it may require tissue expanders to reach the lowermost part of the nose (3,4). In our study, distant V-Y plasty was easily used in the repair of medium and large defects of the nasal dorsum.…”

“…Millard (4), Burget and Menick (2), and Ogino (5) used forehead flaps in repair of the nasal dorsum, and obtained good cosmetic results. This was supported by Yotsuyanagi et al (3). Although various skin flaps were described, there was still debate about the ideal technique, because most of these techniques had some disadvantages such as colour mismatch, dog-ear formation, thickness of flaps and requirement of other surgical steps for revision.…”

Defect Reconstruction of the Nose After Surgery for Nonmelanoma Skin Cancer: Our Clinical Experience

“…Nasolabial flaps are suitable for use in the repair of defects up to 2 cm in diameter in the ala nasi, although they are inconvenient to use in the nasal tip and upper part of the nose (32). Nasolabial flaps were used in 34, one, and three lesions in the ala nasi, sidewall, and columella, respectively, in the present study.…”

Reconstruction of the Nasal Defects by Nasolabial Flaps

“…Resurfacing of a nasal defect should include a consideration of the principle of aesthetic subunits [5], Millard adapted Gonzales-Ulloas concept of (regional esthetic units) to nasal reconstruction (Fig. 1).…”