Various Methods of Reconstruction in Nasal Defect

Kim, Seok Kwun; Yang, Jin Il; Kwon, Yong Seok; Lee, Keun Cheol

Abstract

PURPOSE
Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps.
METHODS
From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor(18 cases), trauma(11 cases), inflammation from foreign body reaction(5 cases) and congenital malformation(2 cases). The sites of the defects were ala(22 cases), nasal tip(8 cases) and dorsum(6 cases). The thickness of the defects was skin only(5 cases), dermis and cartilagenous layer(7 cases) and full-thickness(24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below 0.25cm2 were covered with composite graft or full-thickness skin graft.
RESULTS
The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match.
CONCLUSION
The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.