Reconstruction of nasal tip and columella

Microsurgical Reconstruction of the Columella

BACKGROUND

Traditionally, the columella can be difficult to reconstruct because of its unique contours, paucity of adjacent soft tissues, and tenuous vascularity. When local or regional tissues are unavailable, microsurgical transfer can provide a means for reconstruction. In this retrospective review, the authors report their experience with microsurgical reconstruction of the columella.

METHODS

Seventeen patients were enrolled in this study and divided into two groups: group 1, isolated columella defects; and group 2, defects of the columella and portions of adjacent soft tissues.

RESULTS

There were 10 patients in group 1. Their average age was 41.2 years. Average follow-up was 10.1 years. Causes of the columellar defects included trauma, complication of nasal reconstruction, and complication of rhinoplasty. The first dorsal metacarpal artery flap was used in seven cases, and the radial forearm flap was used in five. Two flap losses were salvaged with a second free flap. The average number of surgical revisions was 1.5. In group 2, there were seven patients with an average follow-up of 10.1 years. Causes of the columella defects included cocaine injury, carcinoma, and complication of rhinoplasty. The average number of surgical revisions was 3.3. The radial forearm flap was used in all cases. There were no flap losses. All 17 cases in this series were brought to a successful conclusion.

CONCLUSIONS

The authors' experience shows that microsurgical reconstruction of the columella provides a reliable and aesthetic means for reconstruction. This technique avoids the facial disfigurement and visible scarring that often accompany use of local flaps. In addition, microsurgical flaps can be preformed "off site," which may provide certain advantages in selected cases.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Reconstruction of columella and nasal vestibuli by bilateral nasolabial flaps – A case report

Introduction and importance

The nose is a common location for non-melanoma skin cancers. Resection of such cancers can result in large, multilayer defects that are challenging to reconstruct. The surgical approach is determined by multiple factors and the main goal is to obtain a satisfactory functional and aesthetic result. We present a case of reconstruction of the nasal vestibuli and columella by two transnasal nasolabial flaps.

Presentation of case

A 66-year-old male underwent resection of a large squamous cell carcinoma in the right nasal vestibulum that extended through the columella into the left vestibulum. The resection resulted in a multilayer defect including the floor and roof of the right vestibulum, the entire columella, part of the septum cartilage and floor of the left vestibulum. The defect was reconstructed in two stages by bilateral nasolabial flaps, that were brought into the nasal cavity through incisions on the side of the nose and were used to line the vestibuli and sutured to each other medially to form the neocolumella. No complications or surgical site infections were observed.

Clinical discussion

Transnasal nasolabial flaps can be used for larger columellar defects. The length of the flaps in our case provided enough tissue to reconstruct the columella as well as the entire vestibular linings.

Conclusion

We describe a successful reconstruction of the nasal vestibuli and columella with two transnasal nasolabial flaps, which provided an acceptable aesthetic and functional result.

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The columella is one of the most challenging nasal subunits to reconstruct

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Nasolabial flaps are useful in columellar reconstruction. A transnasal approach provides the flap with useful extra length

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An acceptable functional and aesthetic result was obtained using bilateral transnasal nasolabial flaps

Nasal Columellar Reconstruction With Reverse Lateral Nasal Artery Pedicled Nasolabial Island Flap

Nasal columellar is a complex area to reconstruct due to its unique esthetic and functional characteristics. Malignancy, trauma, infection, and esthetic surgery complications can cause columellar defect. Among many surgical plans, nasolabial island flap is most commonly used. However, flap congestions occasionally occur which inevitably lead to leech therapy. The authors introduce reverse lateral nasal artery pedicled nasolabial island flap, which has lower risk of postoperative complications.

Comparison of aesthetic facial criteria between Caucasian and East Asian female populations: An esthetic surgeon's perspective

Objective aesthetic criteria are important for patient evaluation and analysis during aesthetic surgeries, while successful aesthetic surgeries must take into account the underlying ethnic differences. The aim of this study is to help surgeons and scientists better plan facial aesthetic surgeries and understand the aesthetic needs according to different patients by reviewing and comparing the current aesthetic principles and preferences in Caucasian and East Asian populations. PubMed and The Cochrane Library were searched using keywords regarding anthropometric measurements. Only original clinical studies and reviews written in English and Chinese and those that focused on the objective assessment of facial aesthetics in Caucasian and East Asian female populations were retained for review. Reference lists of the selected articles were also reviewed for eligible studies. Sixty-five articles that described objective aesthetic criteria in Caucasian and East Asian female populations were found through PubMed, among which 47 included Caucasian populations and 18 included East Asian populations. Compared with White women, East Asian women prefer a small, delicate, and less robust face, lower position of double eyelid, more obtuse nasofrontal angle, rounder nose tip, smaller tip projection, and slightly more retruded mandibular profile. Various differences exist between objective facial aesthetic criteria in Caucasian and East Asian populations. Further studies that focus on the objective aesthetic criteria of facial attractiveness in different ethnicities need to be conducted, especially in Asian countries. Level V: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Reconstruction of a large through-and-through defect of the nasal tip using a modified auricular composite graft

INTRODUCTION

The nose is the most important part in the aesthetic appearance of the face because of its central position. It is difficult to reconstruct a large through-and through defect of the nasal tip among nasal defect deformities because of its unique individual characteristics. In this article, we describe the successful use of a modified auricular composite graft (larger than traditional size) for the reconstruction of large transmural defects of the nasal tip.

PATIENTS AND METHODS

We retrospectively examined 4 patients diagnosed with a defect of the nasal tip between 2009 and 2011; in our patients, the size of the defect was between 2 × 1 cm and 2.5 × 1 cm. All of them received the same surgical method. The patients were followed up from 3 to 12 months. After the operation, the patients had hyperbaric oxygen therapy for 7 days to improve graft oxygenation.

RESULTS

All patients attained relatively full-bodied and smooth nasal contours as well as inconspicuous scars and found their reconstructed nasal tip and alae to be aesthetically satisfactory. Two patients experienced partial epidermal necrosis of the transplanted auricular composite grafts, which was recovered by saline-moistened gauze dressing. All the auricular composite tissue flaps had color change, and the contours of donor ears had little change.

Reconstruction of the nasal infratip, columella, and soft triangle

BACKGROUND

Tumors of the soft triangle and distal nose are common, and the wounds created when removing them are among the more challenging defects to repair.

OBJECTIVE

Reconstruction of the soft triangle, infratip, and columella requires attention to form and function beyond what is usually needed in cutaneous surgery. The complexities of the anatomy demand meticulous planning and surgical execution. In this review, the goal is to provide the cutaneous surgeon with a logical approach to repair this challenging region.

METHODS

Skin grafts, composite grafts, local flaps, and pedicle flaps are presented with pearls and pointers. Cartilage grafting for stability is reviewed and detailed. A step-by-step approach allows the surgeon to plan appropriately and execute repairs with excellence.

RESULTS

Ten cases are reviewed in sequential photo format to demonstrate successful reconstruction of operative wounds from this challenging region of the nose.

CONCLUSION

The most distal nasal contours pose many challenges for reconstruction. Success depends on a good knowledge of anatomy, rigorous planning, and superior surgical skills. Skin grafts, composite grafts, local and interpolated flaps are all options that need to be considered when recreating the delicate folds and contours of this region. Cartilage support may be needed to maintain structural integrity. With care, excellent outcomes are predictably achieved.

High-grade mucoepidermoid carcinoma of the columella successfully reconstructed using bilateral nasolabial flaps set up in a sandwich shape and an auricular cartilage graft after surgical resection

Mucoepidermoid carcinoma (MEC) usually originates from the salivary glands. However, there has been no report on mucoepidermoid carcinoma of the columella. In this study, we report the case of a high-grade MEC of the columella that was successfully reconstructed after surgical resection with bilateral nasolabial flaps set up in a sandwich shape and an auricular cartilage graft. A 66-year-old man presented with a nodule on the columella. Histological findings were suggestive of a high-grade mucoepidermoid carcinoma. Wide excision was performed, and the defects of the columella and the nasal floor were reconstructed with bilateral nasolabial flaps set up in a sandwich shape and an auricular cartilage graft. The postoperative cosmetic result was good with excellent tissue texture. The reconstructed columella had an appropriate, not bulky, width as well as satisfactory height and depth. This reconstructive technique is particularly useful for correcting the large defect of the columella with nasal septum and/or nasal floor defects.

Coverage of skin defects without skin grafts using adipose-derived stem cells

A satisfying result is difficult to achieve in the repair of a full-thickness skin defect in the facial area, including the subunits of the nose. A full-thickness skin graft, nasolabial flap, or forehead flap as a major treatment still is used despite its relative potential for secondary contracture, unmatched skin color, hypertrophic scars, and donor-site morbidity. Another option, with good wound-healing power and soft tissue regeneration without skin grafts would be helpful for initiating treatment. Adult stem cells are a useful material in tissue engineering. Adipose-derived stem cells (ADSCs), an abundant population of pluripotent cells found in the stroma of adipose tissues, have been shown to differentiate in vitro into various cell lineages. As a robust source of bioactive growth factors, ADSCs contribute to recovery from ischemic damage, and they can promote the wound-healing process as well as soft tissue regeneration. The authors have experienced several cases of facial skin defect repair using ADSCs without skin grafts. In these cases, they observed rapid coverage of the wound with the patient's own regenerated tissue. During the treatment period, ADSC treatment showed an excellent wound-healing process in terms of quantity and quality.