Nasal Reconstruction

Abstract

The face tells the world who we are and materially influences what we can become. The nose is a primary feature. Thin, supple cover and lining are shaped by a middle layer of bone and cartilage support to create its characteristic skin quality, border outline, and three-dimensional contour. The delicacy of its tissues, its central projecting location, and the need to reestablish both a normal appearance and functional breathing make its reconstruction difficult. Nasal repair requires careful analysis of the anatomical and aesthetic deficiencies. Because the wound does not accurately reflect the tissue deficiency, the repair is determined by the "normal." A preliminary operation may be required to ensure clear margins, recreate the defect, reestablish a stable nasal platform on which to build the nose, and prepare tissues for transfer. Major nasal defects require resurfacing with forehead tissue; support with septal, ear, or rib grafts; and replacement of missing lining. This requires a staged approach.

Nasal alar and lobule reconstruction – Case presentation

“…The reconstruction technique of the caudal border of the septum depends on the availability of soft tissue coverage and the size of the defect. If there is sufficient mucosa, a cartilage graft from the rib is the first choice, offering good structural support for the tip 1,6,9 . The graft, tailored appropriately, should be secured to the remnant of the septum and to the anterior nasal spine.…”

“…The vascularized septal graft can be rotated and advanced as much as needed and is attached to the nasal spine. If the rotation creates a dorsal cartilaginous excess, it can be trimmed and used as a free graft if needed 1,9 . Nasal lobule defects should be reconstructed as a single esthetic unit, even if that means excising some normal skin 1,2,6,9 .…”

“…If the rotation creates a dorsal cartilaginous excess, it can be trimmed and used as a free graft if needed 1,9 . Nasal lobule defects should be reconstructed as a single esthetic unit, even if that means excising some normal skin 1,2,6,9 . The size of the defect precludes the use of local flaps, and the most used is the frontal flap 6,7,9 .…”

“…Nasal lobule defects should be reconstructed as a single esthetic unit, even if that means excising some normal skin 1,2,6,9 . The size of the defect precludes the use of local flaps, and the most used is the frontal flap 6,7,9 . Based on the supratrochlear artery, the paramedian frontal flap offers the best matching skin in any amount needed for a nose reconstruction.…”

Reconstruction of the Nasal Defects by Nasolabial Flaps

“…The flap is elevated with only 2 mm to 3 mm thickness of the subcutaneous tissue [12], nasolabial flap can be staged as one stage for small defects < 1.5 cm within the ala or side wall [13] or as two stages or more for larger, deeper defects, nasolabial flap tissues are elevated and transposed (shifted) on a vascular pedicle and the pedicle is divided about three weeks later [13] and the remaining flap can be reinserted in to the cheek [11].…”