gms | German Medical Science

Background: Reconstruction of the nose is one of the roots of facial plastic surgery and nowadays defects of the nose especially after tumor resection offer a common problem.

Methods: There are some principals to be regarded in reconstruction of the nose.

1.

The reconstruction should respect the boarders of the subunits and enlarge the defects according to these principles. Scars after tissue-transfer should never cross these borders.

2.

The tissue, which is transferred to cover the defects should be appropriate in colour and texture. Therefore the skin of the nose or the forehead are suited best.

3.

In full thickness defects each layer has to be reconstructed separately and an cartilaginous support is necessary not only to guarantee the shape but also to prevent the transferred tissue from shrinking.

Results: Based on these principles our strategy is as follows: Minor defects are covered by skin flaps from the nose itself, especially by rotation flaps (Marchac, Heminose) transposition flaps (biloped, triloped) or extension flaps (Rintala). For major defects the paramedian forehead flap in different variations (expanded or non-expanded) is our main workhorse. In full thickness defects and in subtotal reconstruction these methods combined with a reconstruction of the inner layer and covering this by cartilages grafts from the auricle good results can be achieved.

Conclusion: For reconstruction of the nose we prefer local flaps from the nose itself for minor defects, for large defects the paramedian forehead flap designed according to the modifications of Menick and Burget gives excellent results.