Nasal reconstruction

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PURPOSE: This article outlines the management of a rare and severe nasoorbital injury resulting from a chainsaw kickback accident in a 60-year-old male. A meta-narrative review of English, French, and German literature indexed in PubMed, Embase, and the Cochrane Library up to January 8, 2024, accompanies the case report. METHODS: This was a case report combined with a comprehensive review based on the 2011 Oxford Centre for Evidence-Based Medicine's highest and most recent level of evidence (LoE) and highest recommendation grade (RG)...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Prosthetic nasal reconstruction provides a restorative option for patients with nasal defects, and these can be retained with a variety of methods including adhesives and implants. These prostheses can significantly improve appearance, self-esteem, and quality of life for patients and they restore many functions of the external nose. Traditional fabrication methods are often used by the skilled professionals who make these custom prostheses, but digital technology is improving the workflow for design and fabrication of silicone nasal prostheses...

Soft tissue injuries to the midface (and nose) are common causes for seeking trauma care. As trauma patients, observing advanced trauma life support protocols is warranted given the risk of concomitant injuries. Here, options for optimizing tissue preservation, microvascular replantation, non-microvascular tissue replacement, and wound stabilization are discussed. Included in this discussion are data-driven predictors for successful replantation as well as technique descriptions with anatomic references to guide surgeons in choosing optimal donor vessels...

Nasal reconstruction is a challenging practice with the potential for complications. Surgeons can prevent complications through preoperative optimization of patient factors, refinement of intraoperative surgical techniques, and postoperative surgical and nonsurgical wound care. Preoperatively, optimization of modifiable and recognition of nonmodifiable risk factors is paramount. Intraoperatively, meticulous flap design and surgical technique promote healing. In the postoperative setting, attentive wound care, adjuvant therapies, and close follow-up for consideration of additional procedures enhance outcomes...

Nasal reconstruction remains one of the most challenging surgeries for facial plastic and reconstructive surgeons. The addition of defects extending beyond the nose adds a layer of complexity to an already technically demanding surgery. This article will focus on the management of composite defects extending beyond the boundaries of the nose. Surgeons need to have a variety of techniques at their disposal. These complex defects often require multiple local flaps, multiple stages, and, in select cases, free tissue transfer...

Reconstructing the nose poses considerable challenges, even for the most skilled surgeons. Significant nasal reconstructions often require later revisions to address persistent issues in both form and function, and it is crucial to discuss this possibility with the patient before embarking on the reconstructive process. Minor revisions can often be managed by making direct incisions between nasal subunits, coupled with soft tissue sculpting or the use of structural grafts for augmentation. When minor adjustments prove insufficient, the initial reconstruction may need to be entirely revised with a second forehead flap...

The forehead flap is a time-tested and robust resurfacing flap used for nasal reconstruction. Owing to its excellent color and texture match, acceptable donor site morbidity, and robust and independent blood supply that can support both structural and internal lining grafts, this flap remains the workhorse flap for resurfacing large nasal defects. Various nuances of this technique relating to defect and template preparation, flap design, flap elevation, flap inset, donor site closure, and pedicle division are discussed in this article...

When large defects of the nose are present, it is imperative to address all 3 layers: the external skin envelope, the osteocartilaginous support, and the inner mucosal lining. The middle structural framework is the primary factor in determining the overall shape of the nose, in addition to facilitating a functional and patent airway. As such, its reconstruction must be robust enough to provide lasting osteocartilaginous support while minimizing disfiguring bulk. The goal is replacement of missing tissue with grafts of similar strength, size, and shape...

Total nasal reconstruction is a complex challenge due to the need to establish new internal lining, internal structural support, and external skin covering that is both functional and esthetic. The medial femoral condyle corticoperiosteal free flap represents an innovative option for restoration internal structure and internal nasal lining. When used in conjunction with a paramedian forehead flap, acceptable results in both function and esthetics can be achieved.

A successful nasal reconstruction relies heavily on a stable internal lining. Larger defects pose unique challenges for internal lining reconstruction as obtaining tissue of adequate size while maintaining airway patency is difficult. The prelamination technique uses a staged skin graft to the paramedian forehead flap prior to transfer. As such, a composite flap can be later transferred to reconstruct internal and external nasal defects concomitantly. This article reviews the current background, techniques, and clinical considerations in the use of the prelaminated forehead flap for nasal lining reconstruction in partial to total nasal defects...

The reliability of local intranasal flaps speaks to the robust vascularity of the nose, which these flaps are based on. The goals for lining replacement, as in any other area of head and neck reconstruction, is to use tissue that best matches the qualities of what is being replaced. The goal of this review is to describe the extent to which local tissues can be used and when to consider regional flaps when the extent of a local flap will not provide enough coverage.

Defects over 2.0 to 2.5 cm may often require repair with a multistaged forehead flap. However, in some such defects, other options may be available. In this article, the author will review some of these options.

In this review, the paramedian forehead flap indications and uses are reviewed, specifically examining clinical situations where patient selection is important. In these settings, a preoperative discussion with a patient regarding surgical expectations and goals in the setting of their defect is paramount. The authors review the literature regarding the psychosocial aspects of major nasal reconstruction and review preoperative discussion points that are key to a well-informed patient and improved patient satisfaction through the nasal reconstructive process...

This article reviews special considerations in complex nasal defects including treatment of adjacent subunit defects, timing of repair with radiation, reconstruction in patients with prior repairs or recurrent disease, and the role of prosthetics. The role of technological advances including virtual surgical planning, 3 dimensional printing, biocompatible materials, and tissue engineering is discussed.

Owing to the complex, multilayered anatomy of the nose in the central face, major nasal reconstruction can pose a significant challenge for reconstructive surgeons. It is the responsibility of reconstructive surgeons to have an understanding of the most common cutaneous malignancies and excisional techniques that may lead to complex nasal defects. The purpose of this article is to discuss these malignancies, excisional techniques, and impacts of radiation on tissue that has implications for reconstructive surgeons...

BACKGROUND: Full thickness defects of the ala, soft triangle, and nasal tip involving the nasal lining have traditionally been repaired with the three-stage folded paramedian forehead flap (FPFF), with a cartilage graft for support. For similar defects, the authors utilize the two-stage FPFF without cartilaginous support which provides reproducible functional and aesthetic results.  Objective: To describe the authors’ experience with the two-stage FPFF, including outcomes, complications, and design modifications to enhance functional and aesthetic success...

BACKGROUND: The reconstruction of surgical defects in high-tension anatomical regions is challenging due to the ischemia and subsequent necrosis associated with tension closure. Research on new flaps capable of closing these defects exerting less tension would be a tremendous advancement in dermatological surgery. PATIENTS AND METHODS: We conducted a multicenter, retrospective study that used 2 new flaps-the bishop and the sigma ones-to repair surgical defects in high-tension regions such as the scalp, lower extremities, and the nasal pyramid...