Overview:
Dr. Constantine writes about and researches plastic surgery constantly. This magazine article co authored by Dr. C focuses on the delicate and challenging aspects of nasal reconstruction. 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.
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Nasal Reconstruction-An Overview
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.
For the plastic surgeon, nasal reconstruction is the most frequent and most challenging referral after Mohs micrographic surgery. A prominent and defining feature of the face, the nose is a composite structure composed of skin, lining, cartilage, muscular subcutaneous tissue, septum, and bone. All components, including cover, support, and lining, must be restored appropriately to provide an aesthetic and a functionally sound reconstruction. Operative decisions must be made keeping in mind the effects of late scar healing. From the outset, a well-tailored and thorough plan is paramount; however, the surgeon and patient should allow for flexibility, including additional stages if necessary.
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Nasal Reconstruction-An Overview
