Outcomes, Concepts, Technical Refinements, and Challenges in the Microvascular Repair of Full-Thickness Nasal Defects.

Background: Repair of full-thickness nasal defects may require distant tissue, when local or regional donors are inadequate or unavailable. The authors' microvascular designs, technical details, and complications using a radial forearm flap to restore nasal lining have been described in past publications. In this article, the authors review stages 2 through 5, using a forehead flap and rib grafts to resurface the nose and build a support framework.

Microvascular Reconstruction of the Nose with the Radial Forearm Flap: A 17-Year Experience in 47 Patients.

Background: Microvascular reconstruction of the nose was pioneered in China in the early 1970s using the radial forearm flap. Since then, different flaps, methods, and flap designs have been used to improve outcomes. Microvascular tissue transfer has become the first step of multistage reconstruction, which includes rebuilding the nasal framework, transferring a forehead flap for external skin coverage, and sculpting the nose for improved appearance and breathing.

Principles and Planning in Nasal and Facial Reconstruction: Making a Normal Face.

Learning Objectives: After reading this article, the participant should be able to: 1. Understand the rationale and value of principles of facial reconstruction in the complex patient. 2.

Surgical treatment and reconstruction of nonmelanoma facial skin cancers.

Learning Objectives: After reading this article, the participant should be able to: (1) Identify the appropriate resection margins for common types of nonmelanoma skin cancer. (2) Discuss indications for secondary intention healing, skin grafting, and local flaps for reconstruction of facial skin cancer defects. (3) Describe at least one local flap for reconstruction of scalp, forehead, temple/cheek, periocular, nose, and lips.

Primary intranasal lining injury cause, deformities, and treatment plan.

Background: Nasal membranes may be injured by immune disease, infection, trauma, or cocaine. Destruction of the septum, vault and floor lining, external skin, upper lip, and adjacent structures follows.

Methods: Lining injuries caused by cocaine, Wegener granulomatosis, primary syphilis, leishmaniasis, septorhinoplasty, septal cancer excision and irradiation, corrosive inhalation, and foreign body and iatrogenic intubation injury were reviewed.

Revising or redoing an imperfect or failed nasal reconstruction.

Almost all major nasal reconstructions will require a late revision to refine aesthetics and function. The early surgical result after pedicle division will be determined by the materials, methods, priorities, planning, and surgical stages chosen by the surgeon. Imperfections in nasal contour, including recreation of the alar crease and nasolabial fold, are corrected by soft tissue debulking and secondary cartilage grafting through peripheral or direct incisions.

Forehead flap: master techniques in otolaryngology-head and neck surgery.

When the nose is missing, most patients would like to have their normal appearance and function restored. Unfortunately, the wound does not reflect the true tissue loss and the available donor tissues are not similar to nasal tissues. So subunit principles are applied and donor tissues modified to achieve a satisfactory result.

Practical details of nasal reconstruction.

Learning Objectives: Learning Objectives: After reading this article, the participant should be able to: 1. Examine a nasal defect to determine its true dimension and outline and plan the appropriate timing of reconstruction. 2.

Aesthetic and reconstructive rhinoplasty: a continuum.

The anatomy and aesthetics of the nose never change and are similar for cosmetic and reconstructive rhinoplasty. The disciplines differ in the cause of injury, which determines the site and degree of damage, the subsequent deformity, and the therapeutic approach to repair. The cosmetic surgeon modifies the bony-cartilaginous framework to support and mould the overlying skin.

An approach to the late revision of a failed nasal reconstruction.

Background: Most nasal reconstructions previously repaired with regional flaps require a revision to improve appearance and function. Many local flaps also create significant landmark and contour distortions, such as alar crease obliteration or nostril margin malposition.

Methods: Over 400 nasal reconstructions with regional tissues, primarily forehead flaps, and 100 local flap repairs were evaluated to identify the causes of failure of the primary repair, to classify late deformities, and to develop an approach to the late revision of a nasal reconstruction.

Microvascular repair of heminasal, subtotal, and total nasal defects with a folded radial forearm flap and a full-thickness forehead flap.

Background: The site, size, and depth of tissue loss, irradiation, or composite injury to adjacent cheek and lip may make local tissues inadequate or unavailable for the repair of major nasal defects.

Methods: In 13 patients, a single, folded, horizontal radial forearm flap was used to line the vault and columella, with an incontinuity fasciocutaneous extension to resurface the nasal floor, with or without primary dorsal support. Later, excess external forearm skin was turned over to adjust the nostril margin and alar base positions.

Complex nasal reconstruction: a case study: composite defect.

A woman presents after Mohs excision of a basal cell carcinoma within the right alar. A composite defect of her right upper lip, cheek, and ala is present. Although distressed, her concerns are somewhat alleviated by the prior successful reconstruction of a full-thickness defect of her left ala, some years previously.

Nasal reconstruction.

The face tells the world who we are and materially influences what we can become. The nose is a primary feature. Thin, supple cover and lining are shaped by a middle layer of bone and cartilage support to create its characteristic skin quality, border outline, and three-dimensional contour.

Nasal reconstruction with a forehead flap.

The tint of forehead skin so exactly matches that of the face and nose that a forehead flap must be the first choice for reconstruction of a nasal defect. The forehead flap makes by far the best nose. With some plastic surgery juggling, the forehead defect can be camouflaged effectively.

The evolution of lining in nasal reconstruction.

Historically, external skin is the most obvious tissue deficiency after nasal trauma or skin cancer excision. The loss of underlying support and lining is less apparent and practically speaking has been considered an afterthought in the repair of nasal defects. The importance of lining was initially recognized by Keegan and Gillies.

Defects of the nose, lip, and cheek: rebuilding the composite defect.

Background: The face can be divided into regions (units) with characteristic skin quality, border outline, and three-dimensional contour. A defect may lie entirely within a single major unit or encompass several adjacent units, creating unique problems for repair. Composite defects overlap two or more facial units.

A new modified method for nasal lining: the Menick technique for folded lining.

Traditional lining techniques such as prefabricated flaps, hinge-over flaps, or second local flaps for lining are thick, stiff, or poorly vascularized. Support grafts have traditionally been placed incompletely or secondarily. Intranasal lining flaps have revolutionized reconstruction but are complex, tedious, and destructive to the residual nose.