The Subunit Principle in Nasal Reconstruction

Aesthetic reconstruction of the nose following skin cancer

“…Full-thickness grafts more closely resemble normal skin and contract less than split-thickness grafts. The preferred donor site for full-thickness grafts to the nose is the preauricular area [2]. The postauricular and supraclavicular areas also may be useful.…”

“…The superiorly based nasolabial flap is well suited for the reconstruction of an entire alar subunit [2,8]. It may be more useful for those patients who have thicker, fleshier ala. For optimum results, it must be used as a two-stage flap.…”

“…The forehead flap can be made very thin and supple, as long as care is taken to preserve the dermal vessels in the thinned portion. The forehead flap undoubtedly offers the best tissue to replace a full-thickness defect of the entire nasal tip [2]. Larger areas also can be covered, especially if the donor site does not require primary closure.…”

“…Nonetheless, attempted preservation of the supratrochlear vessels is a prudent approach. The base of the flap should be at least 1.2 to 1.5 cm in width [2]. It then should extend directly up the forehead until sufficient length is obtained to reach the most inferior portion of the nasal defect.…”

“…Skin cover also should be planned after considering the nasal subunits. Burget and Menick [2] list the subunits that should be taken into consideration in nasal reconstruction-these are the dorsum, the sidewalls, the ala, the soft triangles, and the tip. The subunits are defined by areas of contour transition, where the character of reflected light changes.…”