What is Nasal Reconstruction?Nasal reconstruction is the surgery or combination of procedures performed to repair a deformity or nasal injury after trauma, skin cancer, birth defects, immune disease or prior failed attempts at nasal repair.
Understanding the structure of the nose is critical to understand the reconstructive procedures.
Anatomically, the nose is composed of three layers: an inner lining, a middle support layer of bone and cartilage, and an outer covering of skin which matches the face in color and texture.
Aesthetically, plastic surgeons describe the nose in terms of units and subunits. Each of these units should be individually analyzed at the time of reconstruction planning.
The nose is divided into the dorsum (bridge), the tip, the columella (the post between the nostrils), and bilateral ala (round subunits above each nostril rim) and sidewalls.
The procedureDefects vary in site, size, shape, depth. They also vary in the anatomic layers injured (cover, lining, or support). However, The Normal does not change. The contralateral Normal – the other uninjured side of the nose or face – or the Ideal – is used as a guide to rebuild the Normal.
The nasal deformity is evaluated during the medical appointment and physical examination. According to the size, location and depth of the defect a treatment plan is designed. Often, previous operative reports, old photographs and imaging tests such as CT scan may be necessary.
There are many ways to rebuild the nose. In some cases, simpler and faster options are enough for a good result. However, the simplest and fastest sometimes is not able to restore the proper shape and function of the nose. In these situations, more laborious and time-consuming procedures are required to achieve the best result.
Simple Suture Closure: Because of the limited amount of extra skin on the nose, only small defects in the upper nose can be sutured and closed without distorting the remaining tip or nostrils.
Skin Grafts: Skin grafts are pieces of skin removed from other regions and positioned where a lesion has been removed. Skin grafts are usually used for small, superficial defects. Unfortunately, the color and texture of skin grafts are unpredictable and a graft can look too pale, too dark, or too shiny, and may not match adjacent normal skin of the nose. They can be quite effective, but may not restore a truly normal appearance.
Local Flaps: There is a only small amount of extra skin within the mobile skin of the upper nose. If the defect is small, the excess can be redistributed and shared to cover a another area. Although a scar remains, flaps usually have an excellent color and texture match, unlike skin grafts.
Local flaps, however, do not add skin to the nose. That is why local flaps should be used cautiously to avoid distortion of the tip or nostril margin due to excessive tension which may pull the residual parts of the nose into an abnormal position.
Regional Flaps: Regional flaps move excess tissue from facial areas adjacent to the nose – the nasolabial fold (the loose skin just lateral to the lip and nose in the smile line) or from the forehead. Depending on the site, size, shape, and depth of the wound, these areas can better provide tissue for larger, more complex repairs. Although they may seem more complicated, they often produce a more reliable and better result.
Forehead Flap: Forehead skin has been acknowledged for centuries as the best donor site for the repair of the nose. Its color and texture are ideal. The final forehead scar, which follows the removal of skin from the forehead, is usually minimal and improves over time.
A forehead flap is used when the nasal defects is deep, large or requires replacement of lining or cartilage support.
It may involve two or three procedures depending on the complexity of the repair.
In the first surgery, a strip of skin extending from the eyebrow to the hairline is elevated and carried to the nose on a vascular pedicle (stalk) which carries its blood supply.
In the second procedure, depending on the complexity of the defect to be repaired, the transposed flap receives cartilage grafts for support and is remodeled, in order to achieve the desired nasal shape. The pedicle is still maintained at this stage.
The last surgery always involves the resection of the pedicle, since the flap would be integrated into the receptor area in the nose, and the artery responsible for its irrigation and maintenance of its viability is no longer necessary.
Complex repairs may be further improved by a later revision to improve the appearance, function, or visible scars.
Dr. Mayra has extensive experience in these complex nasal repairs, having presented her results at conferences and published scientific articles on this technique.
In the medical appointment, the nasal defect is evaluated the and the best treatment strategy is chosen.
Despite all the planning, complications can still happen. The main complications of nasal reconstruction surgery are bleeding, poor healing and partial loss of the flap. It is uncommon that any of these complications changes the result, but any one of them can modify the initial planning and make additional procedures necessary. The end result can take months to be achieved and depends on the decrease in swelling.
Source: www.plasticsurgery.org
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