Nasal Reconstruction: An Overview and Nuances

 

 Buy Article Permissions and Reprints

ABSTRACT

Nasal reconstruction continues to be a formidable challenge for most plastic surgeons. This article provides an overview of nasal reconstruction with brief descriptions of subtle nuances involving certain techniques that the authors believe help their overall outcomes. The major aspects of nasal reconstruction are included: lining, support, skin coverage, local nasal flaps, nasolabial flap, and paramedian forehead flap. The controversy of the subunit reconstruction versus defect-only reconstruction is briefly discussed. The authors believe that strictly adhering to one principle or another limits one's options, and the patient will benefit more if one is able to apply a variety of options for each individualized defect. A different approach to full-thickness skin grafting is also briefly discussed as the authors propose its utility in lower third reconstruction. In general, the surgeon should approach each patient as a distinct individual with a unique defect and thus tailor each reconstruction to fit the patient's needs and expectations. Postoperative care, including dermabrasion, skin care, and counseling, cannot be understated.

REFERENCES

• 1 Burget G C, Menick F J. The subunit principle in nasal reconstruction.  Plast Reconstr Surg. 1985;  76 239-247
  CrossrefPubMedGoogle Scholar
• 2 Barton Jr F E. Aesthetic aspects of partial nose reconstruction.  Clin Plast Surg. 1981;  8 177-191
  PubMedGoogle Scholar
• 3 Singh D J, Bartlett S P. Aesthetic considerations in nasal reconstruction and the role of modified nasal subunits.  Plast Reconstr Surg. 2003;  111 639-648
  CrossrefPubMedGoogle Scholar
• 4 Rohrich R J, Griffin J R, Ansari M, Beran S J, Potter J K. Nasal reconstruction – beyond aesthetic subunits: a 15 year review of 1334 cases.  Plast Reconstr Surg. 2004;  114 1405-1416
  PubMedGoogle Scholar
• 5 Burget G C, Menick F J. Nasal support and lining: the marriage of beauty and blood supply.  Plast Reconstr Surg. 1989;  84 189-202
  CrossrefPubMedGoogle Scholar
• 6 Burget G C, Menick F J. Aesthetic Reconstruction of the Nose. St. Louis, MO; Mosby 1994
  Google Scholar
• 7 Rohrich R J, Muzaffar A R, Adams Jr W P, Hollier L H. The aesthetic unit dorsal nasal flap: rational for avoiding a glabellar incision.  Plast Reconstr Surg. 1999;  104 1289-1294
  CrossrefPubMedGoogle Scholar
• 8 Rieger R A. A local flap for repair of the nasal tip.  Plast Reconstr Surg. 1967;  40 147-149
  PubMedGoogle Scholar

James F ThorntonM.D. 

Associate Professor, Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center

1801 Inwood Rd., Suite WA 4.220, Dallas, TX 75390-9132

Email: James.Thornton@UTSouthwestern.edu