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Antoñanzas J, Tomás-Velázquez A, Salido-Vallejo R, Redondo P. Nasal Dorsum Rotation-Transposition Flap Associated with Guitar-String Sutures: One-Stage Reconstruction of Large Defects on the Nose. J Clin Med 2024; 13:1404. [PMID: 38592209 PMCID: PMC10932222 DOI: 10.3390/jcm13051404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The preferred reconstructive option for closing small- or medium-sized defects of the distal half of the nose is the use of local flaps. The dorsal nasal (Rieger) flap is suitable for closing medium-sized defects at this location, especially when they are medially located, and are wider rather than tall. We describe a rotation-transposition dorsal nasal flap reconstruction for large nasal defects. The novelty of this design includes the addition of a small transposition lobe to the rotation flap, enabling the acquisition of tissue from either the lateral sidewall or the nasolabial sulcus, facilitating closure with guitar-string sutures. (2) Methods: We conducted a retrospective chart review of all the patients with large defects (>20 mm) of the nose who underwent nasal dorsum rotation-transposition flap repair between January 2019 and November 2022 at a single academic center. (3) Results: Fourteen patients (eight males, six females; ages 47-83, mean age 60 years) with defects (range: 20.00-35.00 mm) on the dorsum and nasal tip were recruited. Follow-up duration ranged from 12 months to 3 years, with all cases showing good or excellent oncologic and cosmetic results. (4) Conclusions: The rotation-transposition dorsal nasal flap was demonstrated to be a reproducible one-stage technique for large defects of the dorsum and nasal tip, with minimal risk of aesthetic or functional complications. Guitar-string sutures allowed the reduction of the defect size, facilitating a smaller flap design.
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Affiliation(s)
| | | | | | - Pedro Redondo
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain; (J.A.); (A.T.-V.); (R.S.-V.)
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Zhang X, Song Z, Xu Y, Zheng R, Guo J, Tian L, Wang H, You J, Fan F. Handheld Doppler Detection and Light Illumination for Vascular Mapping in Nasal Reconstruction. J Craniofac Surg 2024; 35:59-62. [PMID: 37702526 DOI: 10.1097/scs.0000000000009737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The application of the expanded forehead flap in nasal reconstruction has the advantage of being able to provide a sufficient amount of flap and can provide good aesthetic results. For an expanded forehead flap to survive, there must be adequate arterial supply and venous return. Despite this, limited studies have been conducted on preoperative vascular mapping and the design of the expanded forehead flap for nasal reconstruction. In this article, the authors present a technique of hand-held Doppler detection with light illumination for vascular mapping. PATIENTS AND METHODS The study included patients who underwent total nasal reconstruction with expanded forehead flaps between May 2016 and April 2021. The design of the flap was based on the result of preoperative vascular detection by hand-held Doppler detection assisted by light illumination. RESULTS A total of 32 patients underwent total nasal reconstruction with an expanded forehead flap. The distal part of the flap became necrotic 1 week after the surgery in 2 patients. Following dressing changes and the administration of antibiotics, the distal flap in these patients survived well. No complications were reported in the long term. CONCLUSIONS Hand-held Doppler detection combined with light illumination is a convenient and effective preoperative design method for nasal reconstruction with an expanded forehead flap. All flaps survived well in the long term. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Xulong Zhang
- Center of Rhinoplasty and Nasal Reconstruction, Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Facial Cosmetic Surgery. J Oral Maxillofac Surg 2023; 81:E300-E324. [PMID: 37833027 DOI: 10.1016/j.joms.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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4
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Andresen JR, Scheufler O. [Cosmetic outcome of nasal tip reconstruction with the frontonasal flap and other locoregional flaps - Cosmetic Outcome of Nasal Tip Reconstruction]. HANDCHIR MIKROCHIR P 2023; 55:278-286. [PMID: 37224879 PMCID: PMC10415061 DOI: 10.1055/a-2069-2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND This study investigates the results of nasal tip reconstruction with the frontonasal flap compared with other locoregional flaps. MATERIAL AND METHODS All nasal tip reconstructions with locoregional flaps performed during a 10-year period were included. Defect size, flap type, risk factors, comorbidities, complications, revisions, and secondary operations were retrospectively assessed. Clinical follow-up examinations were performed after 12 months. Digital photographs were taken in standard projections preoperatively and at the time of the last follow-up examination, and the aesthetic results were assessed by three independent examiners, with nasal contour, symmetry, scarring, and match of skin colour between flap and nasal skin rated on a 4-point scale. Finally, patient satisfaction was obtained. RESULTS A total of 112 nasal tip reconstructions were performed in 68 women and 44 men with a mean age of 71,4±10,2 years. Taking into account defect size, individual factors and patient preference, reconstruction was performed with 58 frontonasal flaps, 23 Rintala flaps, 20 paramedian forehead flaps and 11 bilobed flaps. Mean age and comorbidities of patients were comparable between flap types, except for a higher incidence of arterial hypertension and a lower incidence of diabetes mellitus in patients treated with frontonasal flaps. Defect size was the same in reconstructions with frontonasal flaps and Rintala flaps, smaller in bilobed flaps, and more extensive in paramedian forehead flaps. There were no differences in complication rates between the different flap techniques. Taking into account the planned second interventions (flap pedicle separations) in the paramedian forehead flaps, the frequency of unplanned corrections was comparable for all flap techniques. Aesthetic results and patient satisfaction were rated as very good or good in more than 90% with all techniques. CONCLUSIONS Compared with the paramedian forehead flap, the frontonasal flap avoids a planned secondary procedure and an extensive donor defect. It allows for the coverage of defects at least the size of the Rintala flap and larger defects than the bilobed flap.
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Affiliation(s)
- Julian Ramin Andresen
- Klinik für Orthopädische-, Unfall-, und
Wiederherstellungschirurgie, Charite Universitätsmedizin Berlin - Campus
Benjamin Franklin, Berlin, Germany
| | - Oliver Scheufler
- Plastische und Ästhetische Chirurgie, AARE KLINIK, Bern,
Switzerland
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Desisto NG, Ortiz AS, Yang SF, Stephan SJ, Patel PN. State of the Evidence for Facial Skin Cancer Reconstruction. Facial Plast Surg 2023; 39:220-229. [PMID: 36603830 DOI: 10.1055/a-2008-2798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This review provides a comprehensive presentation of the evidence available in facial reconstruction post-Mohs micrographic surgery. Given the large diversity in post-Mohs reconstruction, there are limited guidelines in the management of defects. The aim of the present work is to provide a review of the best evidence as it pertains to several considerations in facial reconstruction. Data suggests that Mohs micrographic surgery and many reconstructive procedures can be performed as outpatient procedures under local anesthesia, with narcotic pain medication only given in certain patient populations following a minority of reconstructive procedures. Perioperative and topical antibiotics are generally not indicated. Aspirin and warfarin can generally be continued for most reconstructive procedures, but clopidogrel and novel anticoagulants may predispose to increased bleeding complications. Delayed reconstruction appears to be safe, although data are discordant on this topic. No specific wound closure technique or suture choice appears to be consistently superior. Given the lack of robust comparative studies, consistent methodology, and variable defect sizes/locations, no robust evidence-based guidelines can be generated for reconstruction techniques of facial subsites.
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Affiliation(s)
- Nicole G Desisto
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra S Ortiz
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shiayin F Yang
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott J Stephan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Priyesh N Patel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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Song Z, Zhang X, Wang H, You J, Zheng R, Xu Y, Guo J, Tian L, Fan F. Nasal reconstruction with the expanded forehead flap: Long-term follow-up of esthetic outcome and 12-year experience. J Plast Reconstr Aesthet Surg 2023; 83:109-116. [PMID: 37276728 DOI: 10.1016/j.bjps.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/20/2022] [Accepted: 04/11/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The expanded forehead flap has its unique advantage in nasal reconstruction. The authors present their 12-year experience with nasal reconstruction with an expanded forehead flap. The esthetic and functional outcomes were assessed with long-term subjective and objective evaluations. METHODS A retrospective analysis was conducted of consecutive patients who underwent nasal reconstruction with the expanded forehead flap from 2009 to 2021 performed by the senior author (F.F.). Data were collected and analyzed regarding defect characteristics, processes of treatment, and complications. Subjective esthetic and functional outcomes were assessed through questionnaires FACE-Q (Face Questionnaire) and NOSE (Nasal Obstruction Symptom Evaluation). The objective esthetic outcome was assessed by a senior resident through the viewing of clinical photographs. RESULTS One hundred and fifty-five patients underwent nasal reconstruction with an expanded forehead flap. The average expansion period was 174 days, and the injection volume was 685.7 ml. There were 15 complications. One hundred and eight patients (69.6%) were satisfied, and 19 patients (12.2%) were very satisfied with the outcome. The differences between postoperative and preoperative scores of FACE-Q were statistically significant (p < 0.01). Sixty-nine percent of patients complained of bilateral eyebrow asymmetry, 27.1% of patients reported partial recovery of frontal deformity with dissatisfaction, and 2.6% of patients considered not recovered at all. The results of 78 patients (50.3%) were considered "satisfied," and 41 patients (26.5%) were considered "very satisfied" by objective evaluation. CONCLUSION Nasal reconstruction with an expanded forehead flap was a safe technique with good esthetic outcomes. Although problems with the asymmetry of the eyebrows and frontal deformation were presented, the influence was minimal and well-accepted by most patients.
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Affiliation(s)
- Zhen Song
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xulong Zhang
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huan Wang
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianjun You
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruobing Zheng
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yihao Xu
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junsheng Guo
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Tian
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Fan
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Veerabagu SA, Perz AM, Lukowiak TM, Lee MP, Neal D, Aizman L, Miller CJ, Golda N, Albertini JG, Chen D, Bar A, Leitenberger J, Maher IA, Sobanko JF, Hollmig T, Aasi S, Sutton A, Higgins Ii HW, Shin TM, Weinberger C, Mattox A, Wysong A, Nugent ST, Etzkorn JR. Patient-Reported Nasal Function and Appearance After Interpolation Flap Repair Following Skin Cancer Resection: A Multicenter Prospective Cohort Study. Facial Plast Surg Aesthet Med 2023; 25:113-118. [PMID: 35950993 DOI: 10.1089/fpsam.2021.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Among patients undergoing two-stage interpolated flap repair of nasal defects, nasal function, and appearance before surgery and at 16 weeks after flap takedown were compared using the Nasal Appearance and Function Evaluation Questionnaire (NAFEQ). Design: Multicenter prospective cohort study. Methods: Adult patients with a nasal skin cancer anticipated to require two-stage interpolation flap repair completed the NAFEQ before surgery, at 1 week after flap placement, 4 weeks after flap takedown, and 16 weeks after flap takedown. Results: One hundred sixty-nine patients were enrolled, with 138 patients completing both presurgical and 16-week post-takedown NAFEQs. Overall NAFEQ score increased by 1.09 points (1.91% improvement, confidence interval [95% CI -0.34 to 2.53]). NAFEQ functional subscale increased by 0.72 points (2.58% increase; 95% CI [0.10-1.35]) and appearance subscale increased by 0.37 points (1.28% improvement, 95% CI [-0.65 to 1.39]). Conclusion: At 16 weeks after flap takedown, patients' perceptions of their nasal function and appearance are similar to or slightly improved when compared with their presurgical assessments.
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Affiliation(s)
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael P Lee
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Donald Neal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicholas Golda
- Department of Dermatology, University of Missouri, Columbia, Missouri, USA
| | | | - David Chen
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Anna Bar
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Justin Leitenberger
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tyler Hollmig
- Division of Dermatology, University of Texas Dell Medical Center, Austin, Texas, USA
| | - Sumaira Aasi
- Department of Dermatology, Stanford University, Stanford, California, USA
| | - Adam Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - H William Higgins Ii
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Weinberger
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Adam Mattox
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shannon T Nugent
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Grigore A, Oproiu AM, Florescu IP. Aesthetic Principles in Nasal Reconstruction after Squamous Cell Carcinoma Resection. ROMANIAN JOURNAL OF MILITARY MEDICINE 2023. [DOI: 10.55453/rjmm.2023.126.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
"A successful nose reconstruction is represented by a normal look and nasal breathing preservation. The choice of method is based on the site, size, depth of the defect, donor availability, and surgeon experience. There are multiple methods of restoring nasal cover, from primary repair to healing by secondary intention, from primary suture, skin graft to locoregional flaps, but all of them should be integrated into a personalized approach, keeping the nasal functions, a good aesthetic outcome and without any tumor infiltration. This paper consisting of a retrospective study of 9 patients diagnosticated with squamous cell carcinoma revealed the importance of skin properties and skin changes during aging. Despite all aesthetic principles, skin is the most important resource in facial reconstruction. "
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Núñez-Castañeda JM, Chang-Grozo SL. Surgical Treatment and Reconstruction of Nasal Defects According to the Aesthetic Subunits Principles. Indian J Otolaryngol Head Neck Surg 2022; 74:305-313. [PMID: 36213475 PMCID: PMC9535075 DOI: 10.1007/s12070-021-02475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to determine the prevalence of nasal skin cancer, its location by facial aesthetic subunits and the type of reconstructive procedures performed for each nasal subunit after excision for nasal skin tumors. Observational cross-sectional study of all consecutive patients with the diagnosis of skin tumor located in the nasal unit, treated from 2018 to 2019 by the department of head and neck surgery of a general hospital. 60 patients were treated with nasal skin tumors excisions. A total of 52 patients (86,6%) had basal cell skin cancer, 7 (11,6%) had squamous cell skin cancer and 1 (1,6%) had melanoma. Fifty-nine patients (98.33%) presented a primary tumor and just 1 case (1,66%) recived a previous surgical treatment. Regardless of the type of tumor, the tip subunit was the most often involved with 29 (48,33%) cases in total. Despite of the nasal aesthetic subunit affected, the most frequent type of procedure used for reconstruction was the rotation or advancement flap, based on aesthetic nasal subunits, which was performed in 39 cases (65%). Nasal reconstruction after skin cancer can be very complex, especially since all patients have high expectations about the results. In order to achieve good results, there is a necessity for careful analysis of the defect, correct planning and excellent technical execution of the procedures Frequently, staged procedures will be needed to achieve an optimal result.
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Affiliation(s)
- José Miguel Núñez-Castañeda
- Head, Neck and Maxillofacial Surgery Service, Hospital Nacional Dos de Mayo, Parque “Historia de la Medicina Peruana”, S/N, Av. Miguel Grau 13, Cercado de Lima Lima, Perú
| | - Silvana Lucia Chang-Grozo
- Head, Neck and Maxillofacial Surgery Service, Hospital Nacional Dos de Mayo, Parque “Historia de la Medicina Peruana”, S/N, Av. Miguel Grau 13, Cercado de Lima Lima, Perú
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
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Kim MJ, Lim H, Park DH. Current strategies for aesthetic soft tissue refinement in nasal reconstruction. Arch Craniofac Surg 2022; 23:95-102. [PMID: 35811340 PMCID: PMC9271655 DOI: 10.7181/acfs.2022.00689] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 11/25/2022] Open
Abstract
The challenges of successful nasal reconstruction, which are related to the anatomical complexity of the region, have been extensively studied. Revisional operations are often required to achieve proper nasal reconstruction, with results resembling the premorbid nasal status. This is necessary to ensure the quality of life of skin cancer patients. Fundamental nasal reconstruction requires both proper soft tissue coverage and proper function. However, earlier studies in the field primarily focused on the functional aspect of nose reconstruction, although the cosmetic aspect is also an important factor to consider. In response to this need, many recent studies on nose reconstruction have proposed various refinement strategies to improve aesthetic satisfaction. Most plastic surgeons accept the nasal aesthetic subunit principle as a standard for nasal reconstruction. This review outlines the commonly used surgical refinement options and management strategies for postoperative complications based on the subunit principle. In patients with nasal defects, a proper technical strategy might help minimize revision operations and optimize the long-term results.
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Affiliation(s)
- Min Ji Kim
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hyoseob Lim
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Dong Ha Park
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
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Yen CI, Yeow JYJ, Chang CS, Hsiao YC. Upper Margin of the Forehead Flap and Its Correlation With Aesthetic Results in Nasal Reconstruction in Fitzpatrick Skin Type III and IV Chinese. Dermatol Surg 2022; 48:39-42. [PMID: 34537781 DOI: 10.1097/dss.0000000000003225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The forehead flap is one of the most commonly used methods for nose reconstruction. OBJECTIVE To determine the ideal upper margin of the flap in nasal reconstruction and its correlation with aesthetic results. METHODS From April 2013 to September 2017, 40 patients underwent nasal reconstruction involving the dorsum with a forehead flap. The authors hypothesized 5fdifferent levels as the position to place the upper margin of the forehead flap: (1) glabella, (2) level of the upper eyelid, (3) intercanthal line, (4) horizontal line between the keystone and intercanthal line, and (5) the keystone. Then they photoshopped the upper margins of the forehead flap at 5 different levels and designed a questionnaire. Nasal reconstructive plastic surgeons, medical practitioners, and people without medical backgrounds chose the most aesthetically pleasing photograph for every patient. RESULTS The questionnaire showed that the most aesthetically pleasing positions were located at glabella (n = 0), level of upper eyelid (n = 9), intercanthal line (n = 24), the line between keystone and intercanthal line (n = 6), and keystone (n = 1). CONCLUSION The authors suggest placing the upper margin of the forehead flap at the level of the intercanthal line in nasal reconstruction involving the dorsum to achieve the best aesthetic results.
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Affiliation(s)
- Cheng-I Yen
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Jenny Yun-Jen Yeow
- Department of Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
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Aldabaany W. Reconstruction of Congenital Alar Rim Defects (Tessier Number 1 Cleft) Using Laterally Based Alar Subunit Rotation Advancement Flap. Ann Plast Surg 2021; 87:161-164. [PMID: 34253699 DOI: 10.1097/sap.0000000000002670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alar rim defects develop in most cases as a result of burns, trauma, or tumor excision. Congenital alar rim defects are rare, with an incidence of 1 in 20,000 to 40,000 live births. Tessier classification is the most commonly used classification system for craniofacial defects. Facial clefts involving the nose are categorized as types 0, 1, 2, and 3, whereas cranial clefts with nose lesions are categorized as types 11, 12, 13, and 14. The patterns of nasal clefts are extremely variable, ranging from a simple notch of alar margin to complex craniofacial cleft involving the lip, nose, eyelid, brow, forehead, and underlying bone. PATIENTS AND METHODS This study was conducted at Fayoum University Hospital on 8 male patients who present with congenital alar rim defects (Tessier number 1 cleft). Surgeries were performed under general anesthesia with orotracheal intubation. A full-thickness incision was created along the whole alar subunit, keeping the ala attached only laterally (laterally based alar full-thickness flap). The alar flap was advanced and rotated medially and inferiorly and sutured to the anatomical place in 2 layers, skin and mucosa. Follow-up was done at least 1.5 years postoperatively. RESULTS The study was conducted on 8 male patients presenting with congenital alar rim defects (Tessier number 1 cleft). The mean age of patients was 14.2 years, and the cleft was unilateral in 4 patients (50%) and bilateral in 4 patients (50%). The patients were assessed both aesthetically and functionally and followed at 1.5 years postoperatively. The aesthetic outcome was assessed according to both patients' and author's evaluations of the scar appearance, alar symmetry, nostril symmetry, and general satisfaction. CONCLUSIONS Laterally based alar subunit rotation advancement flap is a reliable option for reconstruction of congenital alar rim defects (Tessier number 1 cleft) with the advantages of being an easy single-stage procedure with good tissue matching and nostril symmetry and only limitation of extremely wide defects with deficient tissues between the ala and tip.
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Affiliation(s)
- Waleed Aldabaany
- From the Department of Plastic Surgery, Faculty of Medicine, and Department of Plastic Surgery, Fayoum University Hospital, Fayoum University, Fayoum, Egypt
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13
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Andresen JR, Scheufler O. Complex nasal reconstruction for skin cancer and posttraumatic deformity using a modified frontonasal flap - Case report. Int J Surg Case Rep 2021; 83:105944. [PMID: 33975202 PMCID: PMC8129936 DOI: 10.1016/j.ijscr.2021.105944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Reconstruction of the nasal tip is challenging, especially when large defects are associated with compromised nasal soft tissues and framework. The frontonasal flap is an axial-pattern myocutaneous flap from the glabella and nasal dorsum that allows for various modifications in flap design to cover medium sized defects of the nasal tip. Case presentation A 66-year-old male patient presented with a large and ulcerated squamous cell carcinoma of the nasal tip that was associated with substantial posttraumatic damage of the nasal soft tissue envelope and cartilaginous vault of the dorsum. Considering patient comorbidity, risk factors, and specific nasal condition, a single-stage tumor resection and reconstruction using a modified frontonasal flap was intended. While tumor excision resulting in a tip defect of 1.5 × 1.5 cm and flap coverage were initially achieved in a single stage, histologically incomplete tumor resection and individual patient requests mandated further surgery, including re-excision, cartilage grafting, and soft tissue contouring. Clinical discussion The frontonasal flap allows for single-stage reconstruction of moderate size tip defects. Even in the case of prior soft tissue damage and scarring, the flap may be used safely pending individual adjustments in flap design. However, additional measures may be employed as needed to optimize the functional and aesthetic outcome in cases of complex nasal pathology. Conclusion In a case with a combined tumor and posttraumatic nasal deformity, an individualized surgical concept incorporating a modified frontonasal flap with adjunct cartilage grafting and soft tissue contouring achieved an excellent functional and cosmetic outcome. Nasal tip reconstruction can be performed with various grafts and flaps. The frontonasal flap allows single-staged reconstruction of tip defects. Previous nasal trauma can impair frontonasal flap reconstruction. A modified frontonasal flap with adjunct procedures is presented. The modified frontonasal flap obtained an excellent functional and aesthetic result.
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Kim MJ, Choi JW. Total nasal reconstruction with a forehead flap: Focusing on the facial aesthetic subunit principle. J Plast Reconstr Aesthet Surg 2020; 74:1824-1831. [PMID: 33386264 DOI: 10.1016/j.bjps.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 11/04/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
The nasal aesthetic subunit principle has been widely accepted as the standard for nasal reconstruction with forehead flaps. However, in our experience, one's impression of a reconstructed face can easily be represented by the nose's entire appearance rather than a single nasal component. Accordingly, we hypothesized that total nasal reconstruction focusing more on the facial aesthetic subunit principle would be superior to focal nasal subunit partial reconstruction. Here, we investigated the indication range of total nasal reconstruction and analyzed its effectiveness. Between July 2006 and December 2017, 32 patients who underwent total or subtotal nasal reconstruction were recruited. The total nasal reconstruction group (n = 20) was treated according to our modified facial aesthetic unit concept, while the subtotal reconstruction group (n = 16) was treated according to the nasal aesthetic subunit principle. Using retrospective reviews, we compared surgical details and aesthetic, and functional outcomes with visual analog scale scores. In aesthetic evaluation, nose contour (p = 0.009), nasal symmetry (p = 0.001), and nostril shape (p = 0.041) were superior in the total nasal reconstruction group. Satisfaction regarding the nose (p = 0.036) was significantly higher than that regarding the forehead and labial folds in the total group. Regarding function, there were no significant intergroup differences in nasal airflow, snoring, or olfaction. We suggest that total nasal reconstruction is not a strategy to avoid because of its aggressive nature. For selected suitable patients, the use of the total nose reconstruction focusing on our one nose concept can be a successful surgical option, and the reconstructed nose can be visualized as a real part of the face.
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Affiliation(s)
- Min Ji Kim
- Department of Plastic and Reconstructive Surgery, Ajou University, School of Medicine, Suwon, Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, Ulsan university, College of medicine, Asan medical center, Seoul, Korea.
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15
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Cherubino M, Stocco C, Tamborini F, Maggiulli F, Sallam D, Corno M, Bignami M, Battaglia P, Valdatta L. Medial femoral condyle free flap in combination with paramedian forehead flap for total/subtotal nasal reconstruction: Level of evidence: IV (therapeutic studies): Level of evidence: IV (therapeutic studies). Microsurgery 2019; 40:343-352. [PMID: 31705579 DOI: 10.1002/micr.30532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/11/2019] [Accepted: 10/25/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The nose is a functionally complex organ with also a critical role in aesthetics. For reconstruction of full thickness nasal defects, multiple stages are needed and there is risk for resorption resulting in residual deformity. The aim of this report was to develop and evaluate a new method for full thickness total/subtotal nose reconstruction using the medial femoral condyle free flap (MFCFF) in combination with a paramedian forehead flap. METHODS Between November 2015 and January 2018, eight patients (four males, four females) mean age 52 years (range 40-73 years) undergoing a total/subtotal nasal excision and subsequential reconstruction with MFCFF plus paramedian forehead flap were enrolled. Six cases were squamous cell carcinomas while two were basal cell carcinomas. The MFCFF was stabilized, with the periosteum as inner layer, with plates and a paramedian forehead flap was used as external skin coverage. All patients were evaluated for with postoperative nasal endoscopy and CT scan. A postoperative questionnaire was given 6 months after surgery. RESULTS The mean MFCFF size was 2-3.8 cm × 2.25-2.5 cm with a mean pedicle length of 6.3 cm (range 4.1-9.4 cm). The postoperative period was uneventful. The mean follow-up was 16 months, no bone displacement or resorption was observed at the CT scan, no evidence of nasal stenosis occurred. All patients had a satisfying aesthetic evaluation and a good subjective nasal function. CONCLUSIONS In this series, the MFCFF in combination with the paramedian forehead flap appeared to provide a valid subtotal nose reconstruction, allowing for the recreation of all the three nasal layers and maintaining the nose projection and airway patency in the long term.
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Affiliation(s)
- Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Microsurgery and Lymphatic Surgery Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Plastic Surgery Unit, Microsurgery and Hand Surgery Unit, ASST Settelaghi Varese, Varese, Italy
| | - Chiara Stocco
- Department of Medical, Surgical and Health Sciences, Plastic, and Reconstructive Surgery Unit, University of Trieste, Trieste, Italy
| | - Federico Tamborini
- Plastic Surgery Unit, Microsurgery and Hand Surgery Unit, ASST Settelaghi Varese, Varese, Italy
| | - Francesca Maggiulli
- Plastic Surgery Unit, Microsurgery and Hand Surgery Unit, ASST Settelaghi Varese, Varese, Italy
| | - Davide Sallam
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Martina Corno
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, University of Insubria, ASST Settelaghi Varese, Varese, Italy
| | - Paolo Battaglia
- Department of Otorhinolaryngology, University of Insubria, ASST Settelaghi Varese, Varese, Italy
| | - Luigi Valdatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Microsurgery and Lymphatic Surgery Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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16
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A new flap combination for reconstruction of lower nasal dorsum and supra-tip skin defects. Arch Plast Surg 2019; 46:480-483. [PMID: 31462028 PMCID: PMC6759455 DOI: 10.5999/aps.2018.01354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 06/13/2019] [Indexed: 11/08/2022] Open
Abstract
Repairing surgical defects of the nose is still challenging due to its tridimensional shape and its aesthetic concern. Difficulty in reconstructing nasal subunits lies in their contour, skin texture and limited availability of adjacent skin. For lower nasal dorsum and supra-tip regions, we design a new combined local flap as existing local flaps may give disappointing results. This combination flap was performed on two patients for reconstruction of the lower nasal dorsum area after basal cell carcinoma excision. Size of the excision ranged from 20 to 25 mm diameter and safe margins were obtained. The defects were reconstructed with a local flap that combined a rotation nasal flank flap and a V-Y advancement nasolabial flap. Excision and reconstruction were performed in a one-stage surgery under intravenous sedation and local anesthesia. There were no postoperative complications and no flap loss occurred. Aesthetic and functional results after 6 months postoperatively were satisfying without modification of nasal shape. This flap is reliable and offers interesting functional and aesthetic outcomes. It can be considered as a new reconstruction alternative for supra-tip and lower nasal dorsum skin defects performed in a one-stage procedure under local anesthesia.
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17
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18
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Vandersteen C, Culié D, Dassonville O, Bozec A, Guevara N, Savoldelli C, Poissonnet G. An original procedure for orbitonasal cutaneous infiltrative tumor repair, using combined forehead and melolabial propeller flaps. Eur Arch Otorhinolaryngol 2018; 276:535-540. [PMID: 30519922 DOI: 10.1007/s00405-018-5237-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/02/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Resections of cutaneous tumors in the medial orbitonasal region can be transfixing. Repairs using a single local flap run the risk of failure and that of secondary sinonasal fistula, especially in cases of surgery on a radiated field. We propose an original and reliable repair procedure using two pedicled regional flaps vascularized by two distinct arterial systems clinched together to reconstruct the mucosal and cutaneous planes. MATERIALS AND METHODS A first melolabial propeller flap (MPF) with a superior perforating pedicle was elevated and the cutaneous side was sutured to the deep plane of the loss of substance (mucosal lining). A second homolateral or contralateral paramedian forehead flap (PFF) was then lifted and sutured over the first flap (superficial plane). The forehead pedicle flap was divided at 1 month. RESULTS No trophic complication or failure was recorded on two patients. The 7-year carcinologic, aesthetic, and functional results were satisfying. CONCLUSION This technique involving the superimposition of two local flaps, vascularized by two different arterial systems, appears to offer a simple and reliable repair technique for transfixing cutaneous losses of substance in the medial orbitonasal region. It could be used in the first-line treatment, particularly if an additional radiotherapy is to be performed.
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Affiliation(s)
- Clair Vandersteen
- Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de NICE, 31 Avenue de Valombrose, 06100, Nice, Alpes-Maritimes, France.
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Nice, Alpes-Maritimes, France.
| | - Dorian Culié
- Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de NICE, 31 Avenue de Valombrose, 06100, Nice, Alpes-Maritimes, France
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Nice, Alpes-Maritimes, France
| | - Olivier Dassonville
- Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de NICE, 31 Avenue de Valombrose, 06100, Nice, Alpes-Maritimes, France
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Nice, Alpes-Maritimes, France
| | - Alexandre Bozec
- Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de NICE, 31 Avenue de Valombrose, 06100, Nice, Alpes-Maritimes, France
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Nice, Alpes-Maritimes, France
| | - Nicolas Guevara
- Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de NICE, 31 Avenue de Valombrose, 06100, Nice, Alpes-Maritimes, France
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Nice, Alpes-Maritimes, France
| | - Charles Savoldelli
- Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de NICE, 31 Avenue de Valombrose, 06100, Nice, Alpes-Maritimes, France
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Nice, Alpes-Maritimes, France
| | - Gilles Poissonnet
- Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de NICE, 31 Avenue de Valombrose, 06100, Nice, Alpes-Maritimes, France
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Nice, Alpes-Maritimes, France
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Cerci FB. Usefulness of the subunit principle in nasal reconstruction. An Bras Dermatol 2018; 92:159-162. [PMID: 29267479 PMCID: PMC5726710 DOI: 10.1590/abd1806-4841.20175278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/01/2016] [Indexed: 12/02/2022] Open
Abstract
The subunit principle in nasal reconstruction proposed the concept of
reconstructing the specific topographic subunits that were identified as dorsum,
tip, columella, the paired alae, sidewalls, and soft triangles. In patients with
more than 50% of subunit loss, removing the remaining portion of the subunit and
reconstructing the entire subunit may yield better results. The placement of
incisions along the borders of the subunits minimizes scar lines. Furthermore,
as trapdoor contraction occurs, the entire restored subunit bulges in a way that
mimics the normal contour of a nasal tip, dorsum or ala. Two cases of nasal
reconstruction that followed this important principle are described.
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Affiliation(s)
- Felipe Bochnia Cerci
- Department of Dermatology (Mohs surgery) of Hospital Santa Casa de Curitiba - Curitiba (PR), Brazil.,Department of Dermatology (Mohs surgery) of Hospital de Clínicas da Universidade Federal do Paraná - Curitiba (PR), Brazil
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20
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Marcasciano M, Tarallo M, Maruccia M, Fanelli B, La Viola G, Casella D, Wals LS, Ciaschi S, Fioramonti P. Surgical Treatment with Locoregional Flap for the Nose. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9750135. [PMID: 29435462 PMCID: PMC5757109 DOI: 10.1155/2017/9750135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/22/2017] [Indexed: 12/03/2022]
Abstract
Nonmelanotic skin cancers (NMSCs) are the most frequent of all neoplasms and nasal pyramid represents the most common site for the presentation of such cutaneous malignancies, particularly in sun-exposed areas: ala, dorsum, and tip. Multiple options exist to restore functional and aesthetic integrity after skin loss for oncological reasons; nevertheless, the management of nasal defects can be often challenging and the best "reconstruction" is still to be found. In this study, we retrospectively reviewed a total of 310 patients who presented to our Department of Plastic and Reconstructive Surgery for postoncological nasal reconstruction between January 2011 and January 2016. Nasal region was classified into 3 groups according to the anatomical zones affected by the lesion: proximal, middle, and distal third. We included an additional fourth group for complex defects involving more than one subunit. Reconstruction with loco regional flaps was performed in all cases. Radical tumor control and a satisfactory aesthetic and functional result are the primary goals for the reconstructive surgeon. Despite tremendous technical enhancements in nasal reconstruction techniques, optimal results are usually obtained when "like is used to repair like." Accurate evaluation of the patients clinical condition and local defect should be always considered in order to select the best surgical option.
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Affiliation(s)
- Marco Marcasciano
- Department of Surgery “Valdoni”, Unit of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy
| | - Mauro Tarallo
- Department of Surgery “Valdoni”, Unit of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy
| | - Michele Maruccia
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Benedetta Fanelli
- Department of Surgery “Valdoni”, Unit of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy
| | - Giorgio La Viola
- Dermatology Unit “Daniele Innocenzi”, Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04019 Terracina, Italy
| | - Donato Casella
- Department of Surgery “Valdoni”, Unit of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy
| | - Lenia Sanchèz Wals
- Instituto Nacional de Oncología y Radiobiología, Servicio de Cirugía Reconstructiva, 29 yF Vedado, Plaza de la Revolución, 10400 La Habana, Cuba
| | - Sergio Ciaschi
- Department of Surgery “Valdoni”, Unit of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Fioramonti
- Department of Surgery “Valdoni”, Unit of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy
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21
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Hsiao YC, Chang CS, Zelken J. Aesthetic Refinements in Forehead Flap Reconstruction of the Asian Nose. Plast Surg (Oakv) 2017; 25:71-77. [PMID: 29026816 DOI: 10.1177/2292550317694853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Traditional paramedian forehead flap reconstruction exploits the aesthetic subunit principle. Refinements and outcomes of forehead flap nasal reconstruction largely reflect Western experience. Differences in ethnic Asian anatomy and wound healing may foster suboptimal outcomes. We modified methods to address Asian features by extending subunit and flap boundaries, minimizing flap thinning, and overbuilding the nasal framework to combat contraction and suboptimal scarring. METHODS Between November 2010 and September 2015, 40 Asians were treated for nasal reconstruction with a modified forehead flap technique. Average age of 26 men and 14 women was 50.2 years (range: 10-87 years). Oncologic, traumatic, congenital, and infectious defects involving 1 (37%) or more (63%) subunits were reconstructed. Modifications to the classic forehead flap were extension of involved subunits and flap, conservative flap thinning, and framework overbuilding. RESULTS Patients were followed for 20 months (range: 16 months to 4 years 8 months). Nasal lining was reconstructed with hinge-over lining flaps, forehead flaps, free flaps, or regional flaps. Cartilage was reconstructed in 44 (88%) patients with autologous septum or ear in 33 (75%) cases. Costal cartilage was needed in 11 (25%) cases. In 48 (96%) cases, the ipsilateral forehead was used. There were 5 (10%) wound infections, 2 (4%) dehisced wounds, and 2 (4%) occurrences of distal flap necrosis. Nasal aesthetic results were 72.6% good, 23.3% fair, and 4% poor. Donor site aesthetic results were 74% good and 26% fair. Three case reports are included. CONCLUSION We report favourable results of forehead flap nasal reconstruction using refinements tailored to ethnic Asians.
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Affiliation(s)
- Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Jonathan Zelken
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
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22
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Variations in Frontonasal Flap Design for Single-Stage Reconstruction of the Nasal Tip. Plast Reconstr Surg 2017; 138:1032e-1042e. [PMID: 27537220 DOI: 10.1097/prs.0000000000002785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Single-stage reconstruction of the nasal tip using frontonasal flaps yields variable results. Variations in flap design were used to optimize outcome. METHODS Consecutive nasal tip reconstructions using frontonasal flaps performed by the author during a 6-year period were studied retrospectively. Patients were followed up clinically and charts were reviewed for defect size, vertical orientation (tip versus supratip), and horizontal orientation (central versus lateral). Surgical reports and digital photographs were evaluated for flap design that was adapted to the defect, individual anatomy, and the nasal subunit concept. Flaps were classified by size (standard versus extended), proximal scar configuration (angular versus curved), and distal scar configuration (straight versus stairstep). Surgical complications and aesthetic outcomes were evaluated. RESULTS Twenty-nine frontonasal flaps were performed in 16 female and 13 male patients with a mean age of 73 years. The average defect diameter was 2 cm. The average surface area was 4 cm. Primary defects were located at the tip in 22 cases and the supratip in seven cases, with 19 being lateral and 10 being central. Standard flaps were chosen in 13 patients and extended flaps in 16 patients. Proximal scar configuration was angular in 20 cases and curved in nine cases. Distals scar configuration was straight in 21 patients and stairstep in eight cases. Minor flap complications occurred in eight patients. Outcome was rated good to excellent in 97 percent of patients. CONCLUSION Aesthetically pleasing single-stage reconstruction of the nasal tip is attainable using an anatomically based approach to frontonasal flap design. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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23
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Should we consider the hemi-tip as a proper aesthetic subunit in a nasal reconstruction? J Plast Reconstr Aesthet Surg 2017; 70:1112-1117. [PMID: 28366790 DOI: 10.1016/j.bjps.2017.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/19/2016] [Accepted: 02/17/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Defects involving several aesthetic subunits (ASUs) or lying at the junction of an ASU are challenging and require a complex reconstruction. This study aimed to describe the hemi-tip as a new ASU. MATERIAL AND METHODS We conducted a retrospective study including patients who underwent a nasal reconstruction for lower nasal pyramid defects according to our modified ASU principle. Patients who suffered from a subtotal alar defect, which also involved <50% of the tip, were reconstructed after excising the remaining tissue of the hemi-tip subunit. An aesthetic evaluation was performed using a patient satisfaction scale and by independent raters. RESULTS From 2010 to 2014, 21 patients underwent a lower hemi-nose reconstruction. All patients had a full-thickness defect and underwent a reconstruction of the three layers of the nose. Sixty-four percent of our patients were very satisfied, 26% were satisfied, and only 10% were unsatisfied with their nasal tip appearance, with a mean score of 4.4/5. The nasal tip was also rated by independent raters with a mean score of 4.1/5. DISCUSSION Our results and experience showed that a midline scar between the two hemi-tips is inconspicuous. The majority of the defects involving only one side of the tip would benefit from the hemi-tip ASU reconstruction. CONCLUSION We have modified the number of ASUs by considering the hemi-tip as a proper subunit.
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24
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Vaira LA, Massarelli O, Deiana G, Meloni SM, Dell'aversana Orabona G, Piombino P, De Riu G. Aesthetic and Functional Evaluation of Total Nasal Reconstructions. Indian J Otolaryngol Head Neck Surg 2017; 70:71-78. [PMID: 29456947 DOI: 10.1007/s12070-017-1061-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/09/2017] [Indexed: 12/01/2022] Open
Abstract
The loss of a portion or the totality of the nose has great relevance on the perception of the beauty of a face and can result in a catastrophic quality of life impairment. Several surgical techniques are currently available for the reconstruction of the nasal pyramid. However, there are very few nasal reconstruction quality evaluation protocols that allow the surgeon to choose objectively the best technique for each kind of defects. Six total nasal reconstruction performed in University of Sassari Maxillofacial Unit were evaluated with a protocol that investigate objectively and subjectively the surgical aesthetic and functional outcome. Sensitivity recovery on the reconstructive flaps was also assessed. Patients reported a satisfactory nasal reconstruction both functionally and aesthetically. Sensitivity recovery on the forehead flap was always present even after pedicle resection or in case of traumatic section of the infraorbital nerve. The use of a three layer reconstruction has proved a viable technique both aesthetically and functionally. In particular the use of the forehead flap to reconstruct the outer layer of the nose allows to carry a tissue with very similar characteristics to the original with a recovery of the sensitivity almost complete.
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Affiliation(s)
- Luigi Angelo Vaira
- 1Operative Unit of Maxillo-Facial Surgery, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy.,3Operative Unit of Maxillo-Facial Surgery, University of Naples "Federico II" Hospital, Via Pansini 5, 80131 Naples, Italy
| | - Olindo Massarelli
- 1Operative Unit of Maxillo-Facial Surgery, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy
| | - Giovanna Deiana
- 1Operative Unit of Maxillo-Facial Surgery, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy
| | - Silvio Mario Meloni
- 2Dental School, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy
| | - Giovanni Dell'aversana Orabona
- 3Operative Unit of Maxillo-Facial Surgery, University of Naples "Federico II" Hospital, Via Pansini 5, 80131 Naples, Italy
| | - Pasquale Piombino
- 4ENT Operative Unit, Second University of Naples Hospital, Via Pansini 5, 80131 Naples, Italy
| | - Giacomo De Riu
- 1Operative Unit of Maxillo-Facial Surgery, University of Sassari Hospital, Viale San Pietro 43B, 07100 Sassari, Italy
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25
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Han YE, Lim HJ, Jeong EC, Jin HR. Reconstruction of Subtotal Nasal Defect with Radial Forearm Free Flap and Forehead Flap: A Case Report. JOURNAL OF RHINOLOGY 2017. [DOI: 10.18787/jr.2017.24.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Young Eun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jung Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Cheol Jeong
- Department of Plastic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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26
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Prakash S, Panda R, Kumar V, Saha SS, Choudhary L, Pandey A, Reddy JS. Nasolabial Perforator Flap for One-stage Reconstruction of Nasal Defects. J Cutan Aesthet Surg 2017; 10:22-27. [PMID: 28529417 PMCID: PMC5418977 DOI: 10.4103/0974-2077.204576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The excellent freedom of movement and range of this flap when based on a the nasolabial perforator flap have not been sufficiently explored. In this study, along with demonstrating the other key advantages of this flap over its traditional counterpart, we will endeavour to fill these lacunae in the available literature. Materials and Methods: From February 2009 to February 2012, twenty patients with nasal defects were repaired with a nasolabial perforator flap in the Department of Plastic and Cosmetic Surgery at Sir Ganga Ram Hospital, New Delhi. Of these, two patients (10%) underwent the procedure bilaterally. Thus, a total of 22 nasolabial perforator flap procedures were carried out. Prospectively, collected clinical records and data of each patient were retrospectively retrieved and reviewed to study the nasal defect and surgery done. Results: All the twenty (100%) patients had good functional and aesthetic outcome. All patients who had nasal stenosis preoperatively had very good improvement in the patency of the nasal passages, breathing and nasal blockage with complete recovery of symptoms. The patients were entirely satisfied with the functional recovery. Conclusions: The reliability and versatility of the nasolabial perforator flap exceed its recognised application in reconstruction of nasal defects and it must form a part of every plastic surgeon's armamentarium.
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Affiliation(s)
- Siddharth Prakash
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Ritesh Panda
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Kumar
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Shiv Shankar Saha
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Lalit Choudhary
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Anurag Pandey
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - J Sasidhar Reddy
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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27
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Zelken JA, Reddy SK, Chang CS, Chuang SS, Chang CJ, Chen HC, Hsiao YC. Nasolabial and forehead flap reconstruction of contiguous alar-upper lip defects. J Plast Reconstr Aesthet Surg 2016; 70:330-335. [PMID: 27914865 DOI: 10.1016/j.bjps.2016.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/28/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Defects of the nasal ala and upper lip aesthetic subunits can be challenging to reconstruct when they occur in isolation. When defects incorporate both the subunits, the challenge is compounded as subunit boundaries also require reconstruction, and local soft tissue reservoirs alone may provide inadequate coverage. In such cases, we used nasolabial flaps for upper lip reconstruction and a forehead flap for alar reconstruction. METHODS Three men and three women aged 21-79 years (average, 55 years) were treated for defects of the nasal ala and upper lip that resulted from cancer (n = 4) and trauma (n = 2). Unaffected contralateral subunits dictated the flap design. The upper lip subunit was excised and replaced with a nasolabial flap. The flap, depending on the contralateral reference, determined accurate alar base position. A forehead flap resurfaced or replaced the nasal ala. Autologous cartilage was used in every case to fortify the forehead flap reconstruction. RESULTS Patients were followed for 25.6 months (range, 1-4 years). All the flaps survived, and there were no complications. Satisfactory aesthetic results were achieved in every case. With the exception of a small vertical cheek scar and a vertical forehead scar, all incisions were concealed within the subunit borders. CONCLUSION From preliminary experience, we advocate combining nasolabial flap reconstruction of the upper lip with a forehead flap reconstruction of the ala to preserve normal facial appearance. This combination addresses an important void in the algorithmic approach to central facial reconstruction.
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Affiliation(s)
- Jonathan A Zelken
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan; Department of Plastic and Reconstructive Surgery, Breastlink Medical Group, Laguna Hills, CA, USA
| | - Sashank K Reddy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Cheng-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Hung-Chang Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
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Grandpierre X, Sartre JY, Duteille F. [Reconstruction of superficial defects from the crossroad of nasal subunits, tip, alar lobule and lateral side wall: Study of 36 patients]. ANN CHIR PLAST ESTH 2016; 61:248-56. [PMID: 27087062 DOI: 10.1016/j.anplas.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Conventionally, articles dealing with nasal defects plan reconstructions regarding the aesthetic subunits, imposing their systematic respect. We propose to study the reconstruction of a crossroad region of three subunits, tip, alar lobule and lateral sidewall, where that full compliance is not possible, in our experience of 36 patients. METHODS Our retrospective study from January 2011 to December 2012 focused on patients with a defect in this crossroad region that was repaired by skin graft or flap. We described the population of the study, histological type of the lesions, surgical procedures and complications. We evaluated the reconstructions performed with a photographic review 1 year post-surgery according to the criteria of symmetry, discoloration, thickness, shrinkage, and rating on the Vancouver Scar Scale, which helped create an overall aesthetic score for the reconstruction. RESULTS Of 144 patients with a nasal defect, 36 of them (25%) were included, presenting a defect in our study area. The reconstruction was made by eight hatchet flaps, eight frontal flaps, seven bilobed flaps, five advanced-rotated lateronasal flaps, four nasolabial flaps, two Rybka flaps and two total skin grafts. The advanced-rotated flap, hatchet flap and bilobed flap had the highest results and scores, according to the criteria assessed. Rybka flap and total skin grafts had the lowest results. CONCLUSION The occurrence of a defect in the crossroads seems common. In this indication, specific local flaps had a favourable outcome, including review of the overall esthetic score which was created to standardize the assessment of reconstructions.
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Affiliation(s)
- X Grandpierre
- Service de chirurgie plastique et brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - J Y Sartre
- Service de chirurgie plastique et brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Clinique Jules-Verne, 2, route de Paris, 44300 Nantes, France
| | - F Duteille
- Service de chirurgie plastique et brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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Surgical Treatment and Recurrence of Cutaneous Nasal Malignancies: A 26-Year Retrospective Review of 1795 Patients. Ann Plast Surg 2015. [PMID: 26207539 DOI: 10.1097/sap.0000000000000329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Frequent localization of facial malignancies in the nasal area and their required complete surgical extirpation pose a significant challenge to the plastic surgeon, who is called to perform a suitable delicate reconstruction of produced nasal skin defects. The present study was aimed to examine the role of tumor characteristics in the prognosis of patients with nasal skin cancer undergoing surgical management.A retrospective review of 1795 patients operated on for nasal cutaneous neoplasms during a 26-year period is presented in our study. Descriptive statistics were appropriately calculated; multivariate Cox regression analysis was performed regarding the possible risk factors for recurrence. Only those with a complete follow-up were included in the study. The mean age of our study population was 66.7 years with a male majority (52.4%). Basal cell carcinoma appeared as the most common histological type (87.7%), followed by squamous cell carcinoma (7.9%); the latter correlated with poor prognosis.The nasal sidewalls were the most frequent lesion location (29.8%), followed by the alae (27.8%), dorsum (21.7%), and tip (19.3%). The columella was very rarely affected (0.5%) but was associated with increased recurrence [hazard ratio, 4.74; 95% confidence interval (CI), 1.12-20.00; P = 0.034]. Most patients were treated with elliptical excision and direct closure (58.7%). Local flaps (31.0%) and skin grafting (9.0%) proved very reliable surgical options, especially for larger, high-risk lesions. Recurrence transpired in 46 patients (2.6%) and 4 skin cancer-related deaths occurred.Surgical modality of choice should be individualized and carefully adjusted to patients' needs. Moreover, more elective techniques, such as Mohs micrographic surgery or cumulative therapeutic approaches, like irradiation, should be examined as a beneficial aid to confront high-risk malignancies.
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van Leeuwen AC, The A, Moolenburgh SE, de Haas ERM, Mureau MAM. A Retrospective Review of Reconstructive Options and Outcomes of 202 Cases Large Facial Mohs Micrographic Surgical Defects, Based on the Aesthetic Unit Involved. J Cutan Med Surg 2015; 19:580-7. [PMID: 25986315 DOI: 10.1177/1203475415586665] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND For optimal treatment of facial defects following Mohs micrographic surgery (MMS), the aesthetic unit principles should be applied. Often multiple staged procedures and revisions are necessary. OBJECTIVE To analyze the reconstructive options and outcomes for complex facial defects per aesthetic unit. METHODS Data of 202 patients, who underwent a facial reconstruction at the department of plastic and reconstructive surgery following MMS, were collected. RESULTS The central facial units were affected in more than 70%, with over 20% of the defects involving more than 1 unit. Nasal defects required the longest reconstruction time (3-staged forehead flap) and periocular defects the most revisional procedures. In more than 50%, additional operations (range, 1-5) were needed. In 12%, postoperative complications occurred. CONCLUSION An overview for the reconstructive options of extensive facial skin cancer is presented. Proper treatment requires a structured multidisciplinary approach in order to achieve excellent tumour control and a satisfactory aesthetic and functional end result.
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Affiliation(s)
- Anne C van Leeuwen
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Ayleen The
- Department of Dermatology and Venereology, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Sanne E Moolenburgh
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Ellen R M de Haas
- Department of Dermatology and Venereology, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
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Kim YJ, Cho HH, Kim SO, Lee JB, Lee SC. Reconstruction algorithm for nasal basal cell carcinoma with skin involvement only: analysis of 221 cases repaired by minor surgery. Clin Exp Dermatol 2015; 40:728-34. [PMID: 25959078 DOI: 10.1111/ced.12676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) often occurs on the nose. Reconstruction of the nose should yield excellent aesthetic and functional outcomes. AIM We propose a technical algorithm for the reconstruction of surgical defects, based on our analysis of 221 cases of nasal BCC with skin involvement only, which could be repaired by minor surgery. METHODS The aesthetic and functional outcomes for various reconstruction techniques were analysed according to defect location and size. A reconstruction algorithm was proposed with the aim of obtaining the best surgical results. RESULTS Defect location and size were key considerations. Primary closure was the first option for small defects (< 10 mm), with scores of 3.4 for objective aesthetic outcome (OAO), 3.2 for subjective aesthetic outcome (SAO) and 3.3 for subjective functional outcome (SFO). The first option for medium defects (1-20 mm) was the island pedicle flap, with scores of 3.5 for OAO, 3.2 for SAO and 3.7 for SFO. The first option for large defects (> 20 mm) was the transposition flap for the upper nose (scores of 2.0 for OAO and SAO and 3.0 for SFO) and the interpolation flap for the lower nose (2.8 for OAO and 2.9 for SAO and SFO). CONCLUSIONS We have proposed an algorithm to select the optimal technique for repairing nasal BCC surgical defects according to their size and location.
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Affiliation(s)
- Y J Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - H H Cho
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - S O Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - J B Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - S C Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Cook JL. The reconstruction of the nasal ala with interpolated flaps from the cheek and forehead: design and execution modifications to improve surgical outcomes. Br J Dermatol 2015; 171 Suppl 2:29-36. [PMID: 25124311 DOI: 10.1111/bjd.13206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2014] [Indexed: 11/26/2022]
Abstract
The nasal ala, critically important in the function and appearance of the central face, has significant reconstructive demands given the lack of suitable adjacent donor tissue that can be used to repair all but the smallest surgical defects in this area. Interpolated flaps from the forehead and cheek have long been ideal reconstructive alternatives for the repair of larger or more difficult alar wounds, and with the design and execution modifications described here, the dermatological surgeon can offer more appropriate restoration of this critically important aesthetic unit.
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Affiliation(s)
- J L Cook
- Duke University Medical Center, Durham, NC, U.S.A
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Nasal Reconstruction: A Simplified Approach Based on 419 Operated Cases. Aesthetic Plast Surg 2015; 39:91-9. [PMID: 25413009 DOI: 10.1007/s00266-014-0417-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of this review is to examine a single surgeon's 10-year experience with nose defects and offer a simplified approach for nasal reconstruction to close most nasal defects following Mohs micrographic surgery (MMS). PATIENTS AND METHODS A retrospective chart review was performed on patients undergoing repair of MMS defects of the nose over a 10-year period. Data collected included patients' age and sex, anatomic location of the defect, type of reconstruction, and number of operations required. RESULTS A total of 419 patients were included in this study. The most common location for nasal reconstruction was the nasal dorsum and sidewalls (66.35 %). Complications mainly related to reconstruction of defects of the tip ± ala (n = 31), followed by the ala (n = 15) and the dorsum and sidewalls (n = 13). Bulkiness of the flap used (n = 32) and hypertrophic scar (n = 13) were the most common complications. The bilobed flap was the most commonly used flap (n = 145), followed by nasolabial flap (n = 69), FTSGs (n = 63), forehead flap (n = 62), and dorsal glabellar flap (n = 44). CONCLUSIONS In this article, a simplified approach for nasal defects reconstruction is presented, which is based on commonly performed local flaps and skin grafting. This algorithm can be useful for the novice plastic surgeons in planning a reconstructive strategy that will be efficient, easy to perform, and produces an acceptable esthetic and functional outcome.
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Ghassemi A, Rübben A, Bohluli B, Hölzle F, Ghassemi M. Use of aesthetic rhinoplasty procedures in reconstructive nasal surgery. Br J Oral Maxillofac Surg 2014; 53:44-8. [PMID: 25445386 DOI: 10.1016/j.bjoms.2014.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
Abstract
Resection of cancer often involves the excision of underlying hard tissue, and some procedures in aesthetic rhinoplasty can be used in reconstructive nasal surgery to increase the margin of safety while still achieving an acceptable aesthetic and functional outcome. We have used techniques from aesthetic rhinoplasty to shape the nasal framework. Osteotomy and formation of the tip were used in 17 patients with defects (ranging from 1 to 3.5 cm in size) from the nasal root to the tip of the nose. After the underlying bony or cartilaginous framework, or both, had been removed, the resulting open roof deformity had to be corrected by osteotomy of the bony nasal wall and the tip shaped by excision and suturing, including insertion of the tip graft and columellar strut graft. After this, and narrowing of the nose, the defect was smaller and could be closed with local tissue without tension. There were no deformities in the contour, and patency of the airway was maintained. Patients were satisfied with both the aesthetic and functional results. Although the margin of safety was increased, shaping the nasal framework reduced the size of the defect, which allowed tension-free closure with a local flap. The operation requires a thorough knowledge of procedures used in aesthetic rhinoplasty.
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Affiliation(s)
- Alireza Ghassemi
- Department of Oral, Maxillofacial of Surgery, University Hospital of RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
| | - Albert Rübben
- Department of Dermatology, University Hospital of RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Behnam Bohluli
- Craniomaxillofacial Research Center, Azad University of Tehran, Tehran, Iran
| | - Frank Hölzle
- Department of Oral, Maxillofacial of Surgery, University Hospital of RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Mehrangiz Ghassemi
- Department of Orthodontics, University Hospital of RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
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Reconstruction of full-thickness nasal alar defects using cartilage-supported nonfolded nasolabial flaps. J Craniofac Surg 2014; 23:1624-6. [PMID: 23147290 DOI: 10.1097/scs.0b013e31825bd3ef] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The difficulties faced in the reconstruction of the nasal alar defects are still continuing because of their unique anatomy, free margin, and triple-layered complex structure. In this study, we would like to present the results of the cartilage-supported nonfolded nasolabial flap reconstruction method that we applied to full-thickness alar defects involving the alar rim. Between March 2009 and October 2011, 5 patients with full-thickness alar defects underwent cartilage graft-supported nasolabial flap reconstructions. Three of the patients were men, whereas 2 patients were women. Their median age was 54.2 years (range, 43-62 y). The defects were caused by either tumor excision or trauma. According to the method we applied, cartilage grafts were placed into the pouches formed between the skin and the adipose tissue to provide cartilaginous support to the nasolabial flaps to be adapted to the defect areas. The deep surfaces that were going to form the nasal mucosa were grafted using postauricular full-thickness skin grafts. Patients were followed up for a median period of 7.3 months (range, 3-21 mo). In all patients, the flaps fully fitted the defect areas and provided enough coverage over the defects. Although minimal graft contractions were observed in the later phase because of the cartilage support placed within the pouches formed in the flaps, no nasal airway constrictions were observed.The technique we applied is a simple and reliable method providing adequate framework support, full color and texture harmony, an open nasal passage, and a single-session reconstruction in most cases.
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Meara DJ. Acquired defects of the nose and naso-orbitoethmoid (NOE) region. Oral Maxillofac Surg Clin North Am 2013; 25:131-49. [PMID: 23642667 DOI: 10.1016/j.coms.2013.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nasal injuries coupled with midface fractures of the orbit and ethmoids constitute a nasoorbitoethmoid (NOE) fracture pattern, which is typically the most challenging facial fracture to repair. Hard and soft tissue defects of this region may require advanced reconstruction techniques, including local rotational flaps, free tissue transfer, and even prosthetics. The restoration of form and function dictates treatment, and the success of primary repair is paramount, because secondary correction is challenging in this area of the midface. Because of the complex nature of this region, this discussion is divided into hard tissue defects, with a focus on trauma, and soft tissue defects, with a focus on oncology.
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Affiliation(s)
- Daniel J Meara
- Department of Oral and Maxillofacial Surgery and Hospital Dentistry, Christiana Care Health System, Wilmington, DE 19899, USA.
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Abstract
Alar rim defects are most commonly acquired as a result of trauma, burns, tumor excision or sometimes accompanying craniofacial clefts. However, isolated congenital alar defects are extremely rare occurring in about 1 in 20,000 to 40,000 live births. We are presenting a case report of an isolated congenital cleft of the alar rim. The defect was closed by the use of a rotation advancement full-thickness flap. With this technique, both symmetry and desired thickness of the nostrils were achieved. The skin color and texture of the alar rim were good with minimal scars.
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Affiliation(s)
- R Kannan
- Department of Oral and Maxillofacial Surgery, Vinayaka Mission's Sankarachariar Dental College, Salem, Tamil Nadu, India
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Gaggl AJ, Bürger H, Chiari FM. Reconstruction of the nose with a new double flap technique: microvascular osteocutaneous femur and microvascular chondrocutaneous ear flap--first clinical results. Int J Oral Maxillofac Surg 2012; 41:581-6. [PMID: 22391108 DOI: 10.1016/j.ijom.2012.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 10/26/2011] [Accepted: 02/02/2012] [Indexed: 11/18/2022]
Abstract
This study describes a new microvascular flap combination from the medial femur and ear to reconstruct the nose after subtotal resection and presents the first clinical results. In four patients a squamous cell carcinoma of the nose was registered. In three patients this was diagnosed for the first time while in the fourth patient it was the second relapse after two resections and local flap surgery. In every case, tumour resection ended up in an extended defect of the nose, cheek and upper lip region. For skeletal reconstruction and the inner lining of the nose, a microvascular osteocutaneous femur flap was used. After reconstructing the nasal skeleton, the remaining defect was covered by a microvascular composite flap from the left ear and preauricular region. Both flap pedicles were anastomosed to the facial vein and artery. In every case, the flaps healed without complications. There was no tumour relapse. 12 months after reconstruction, minor surgical corrections were made. The patients showed a satisfying functional and aesthetic result. The combination of a microvascular osteocutaneous femur flap and a microvascular ear flap can be used successfully for reconstructing the nose after subtotal resection.
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Affiliation(s)
- A J Gaggl
- Department of Oral and Maxillofacial Surgery, Paracelsius Medical University LKH-Salzburg, Salzburg, Austria.
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Schreiber NTN, Mobley SR. Elegant Solutions for Complex Paramedian Forehead Flap Reconstruction. Facial Plast Surg Clin North Am 2011; 19:465-79. [DOI: 10.1016/j.fsc.2011.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
With its complex symmetric contours and central facial location, the nose plays a key role in characterizing the face. Among the cosmetic subunits of the nose, the delicate nasal ala has a particularly marked influence on breathing and cosmetic appearance. Therefore, reconstruction of defects of the nasal ala requires careful attention to preserve and restore function and cosmesis. Reconstructive surgeons have a wide variety of options and techniques to repair specific defects of the nasal ala. Attention to detail, knowledge of the nasal anatomy, and precise surgical techniques allows for the optimum results with the lowest risk of complications.
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Affiliation(s)
- Jason D Bloom
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, New York University Medical Center, 550 First Avenue, New York, NY 10016, USA.
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Lohuis PJFM, Godefroy WP, Baker SR, Tasman AJ. Transposition flaps in nasal reconstruction. Facial Plast Surg Clin North Am 2011; 19:85-106. [PMID: 21112512 DOI: 10.1016/j.fsc.2010.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of reconstructive nasal surgery is not only to rebuild all or part of the nose but also to blend and tailor the new and old tissues in such a way as to create the best possible result. Although a variety of reconstructive options exist, local or regional skin flaps are one of the most powerful reconstructive tools for the reconstruction of cutaneous nasal defects. This article discusses the fundamentals of nasal reconstruction and describes the local and regional transposition flaps for the reconstruction of nasal defects.
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Affiliation(s)
- Peter J F M Lohuis
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, The Netherlands.
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Abstract
An ancient Indian medical document, the Sushruta Samhita, describes a technique of using a flap from the forehead for nasal reconstruction. The forehead flap remains the workhorse for major nasal resurfacing today. Contemporary nasal reconstruction with forehead flaps uses the well-established concept of facial and nasal subunits, restoring the three-dimensional morphology by replacing missing tissue with like tissue. This article covers the history of forehead flap surgery, current concepts in flap design, surgical steps, potential complications, defect analysis, lining, framework, and cover as a means of restoring the three-dimensional nasal morphology.
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Affiliation(s)
- Kenneth K K Oo
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA 22908-0713, USA
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Bloom JD, Antunes MB, Becker DG. Anatomy, physiology, and general concepts in nasal reconstruction. Facial Plast Surg Clin North Am 2011; 19:1-11. [PMID: 21112508 DOI: 10.1016/j.fsc.2010.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nasal reconstruction provides a challenging task for any facial plastic surgeon. In performing reconstructive surgery on the nose, one must balance both the functional aspects of the nasal airway with the aesthetic responsibilities of being the central fixture of the face. Before performing surgery, the surgeon must grasp the importance of the anatomic nasal relationships and subunits, the physiology of the skin, the flaps or grafts used to reconstruct these areas, and the basic steps in wound healing. Accurate preoperative planning and analysis of the nasal defect are also vital to producing both an aesthetic and functional nose.
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Affiliation(s)
- Jason D Bloom
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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Abstract
Reconstruction of nasal tip and columella defects is demanding area with a range of reconstructive options, varying in complexity depending on requirements from simple skin grafting to multiple stage reconstruction with regional flaps. A framework is suggested to aid the reader in choice of reconstruction by classifying the defect based on size and the requirements of one to three layer (full thickness) reconstruction.
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Colletti G. Lemmo's flap for nasal dorsum reconstruction. J Oral Maxillofac Surg 2011; 70:672-6. [PMID: 21549474 DOI: 10.1016/j.joms.2011.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 01/24/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Reconstruction of nasal defects is an antique challenge for surgeons. The first reported technique is dated 600 B.C. Since then a number of reconstructive options have been proposed in the literature. Some principles, first stated by Buget and Menick must be always taken into account when planning such reconstructions. In detail, every reconstruction should respect the subunit principle and the scars should always be well hidden in the passage between adjacent subunits. The flap proposed in the present paper adheres to the cited principles and leads to optimal nasal dorsum reconstruction in selected cases. MATERIALS AND METHODS From April 2008 to March 2009, 5 patients were reconstructed with Lemmo's flap after local excision of 3 basal cell carcinomas and 2 squamous cell carcinomas affecting the the skin of the nasal dorsum in its caudal portion. RESULTS In all cases a pleasing aesthetic result was obtained, no postoperative deformity was observed and all the scars were unnoticeable. CONCLUSIONS The Lemmo's flap described in the present paper can be considered a valid choice for nasal dorsum skin reconstruction and is preferable over other techniques for reconstruction of small to medium sized defects of the skin of the caudal dorsum.
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Affiliation(s)
- Giacomo Colletti
- Department of Maxillo Facial Surgery, University of Milan, San Paolo Hospital, Milan, Italy.
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Soft tissue assessment in midface advancement: the use of regional flaps to enhance facial projection. J Craniofac Surg 2010; 20 Suppl 2:1809-11. [PMID: 19816355 DOI: 10.1097/scs.0b013e3181b6c187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Classically, soft tissue repair when indicated is done before or after the skeletal mobilization especially in those cases that present midface deficiency with severe midline soft tissue restriction by scars or congenital affectation. The distraction osteogenesis method has contributed to improve substantially this problem elongating bones, muscles, and ligaments, but some situations need specific and more precise reconstruction of the subunits to gain in aesthetics. The labial-columella junction, the tip of the nose, and the more projecting point of the cheeks are one of these exigent anatomic areas, where only sophisticated reconstruction by flaps can improve facial proportions and projections.
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Jacobs MA, Christenson LJ, Weaver AL, Appert DL, Phillips PK, Roenigk RK, Otley CC. Clinical outcome of cutaneous flaps versus full-thickness skin grafts after Mohs surgery on the nose. Dermatol Surg 2009; 36:23-30. [PMID: 19889165 DOI: 10.1111/j.1524-4725.2009.01360.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A large proportion of facial skin cancers occur on the nose, and defects after Mohs surgery in this location often present a reconstructive challenge. For intermediate-sized defects, the choice of reconstruction is usually between skin flap and full-thickness skin graft. Ongoing debate exists, and limited data are available to determine which of these methods is more satisfactory. OBJECTIVE To evaluate and compare the clinical appearance of wound healing after surgical repair with a skin graft versus a skin flap for Mohs defects on the nose. METHOD In this study, 43 flaps and 24 grafts were evaluated using a modified Hollander Wound Evaluation Scale and a visual analogue scale. RESULTS The mean visual analogue scale score was significantly better for flap repairs than for graft repairs. In addition, 100% of flaps had an acceptable overall cosmetic appearance on the basis of the Hollander Wound Evaluation Scale, compared with only 75% of skin grafts. CONCLUSIONS For defects on the nose where flap and graft repair may both be technically possible, a flap may be more likely to result in superior cosmetic outcome.
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Affiliation(s)
- M Amanda Jacobs
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.
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Abstract
INTRODUCTION Nasal reconstruction after tumor extirpation is a necessity. The aim of the current study was to present the Greek experience in this field for a long period. MATERIALS AND METHODS Charts of patients who underwent nasal reconstruction, from 1985 to 2006, were reviewed retrospectively. They were analyzed in relation to their age, sex, location of the defect, histologic diagnosis of the lesion, type of reconstruction, recurrence of the tumor, and final outcome. RESULTS A total of 1585 patients underwent nasal reconstruction by the senior author (O.P.) during a period of 21 years in our department. A clear male preponderance was shown (845 or 53.3% vs 740 or 46.7%). Their age ranged from 13 to 97 years with a mean of 65.9 years. One thousand five hundred ninety-three different tumors had been resected during the studied period (some patients had >1 lesion). Basal cell carcinoma was the most common type, affecting 1399 patients (87.8%), followed by squamous cell carcinoma, which was identified in 109 patients (6.8%). Cutaneous melanoma was not a frequent diagnosis. Excision and primary closure represented the most frequent type of reconstruction, followed by flap reconstruction and any type of graft. Sidewalls were the usual location in the whole population. Recurrence rate was 3.4%. CONCLUSIONS Nasal reconstruction remains a challenge for every plastic surgeon. Efficient diagnosis and appropriate reconstruction are prerequisites for the final desired outcome.
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