Skin-fat-graft: a simple tool for reconstruction of small deep defects of the nose.

Small deep defects of the nose after resection of benign or malignant skin tumors are a common challenge in facial plastic surgery daily routine. The use of local flaps has several disadvantages for what reason they are a minor or no option especially in certain localizations in the lower third of the nose. Many elder patients suffer from comorbidities where complex more-staged reconstructional procedures drop out. We present a technique of nasal defect closure with a skin-fat composite graft. Between April 2010 and July 2013, we treated 42 patients with a total of 46 skin-fat-grafts to the nose. We reevaluated the esthetic and functional outcome in a retrospective analysis. In 80% of the cases, the results were rated excellent to satisfactory, 20% fair to poor. Reasons for worse validation were color and contour differences of grafts and surrounding tissue as well as alar retraction in very few cases. Nevertheless, we consider skin-fat-grafts to be a useful tool in single-layer nasal reconstruction in defects of smaller size.

One-stage nasal soft tissue reconstruction with local flaps.

Because of better public education and earlier diagnosis of skin tumors, the number of soft tissue defects of the nose with limited size and depth after tumor resection is increasing. A variety of surgical methods such as skin grafts, regional flaps such as forehead flap, and local flaps have been described. The method of choice is dependent on the defect size, localization, skin structure and the wishes and expectations, and general condition of the patient. Nasal reconstruction for soft tissue defects in the supratip area, dorsum, and sidewalls using local rotation and/or advancement flaps is our primary option. But achieving supreme results with these non-subunit-based techniques is still a challenge. Showing schematic figures and case studies, this article is aimed at assisting surgeons in the planning and decision making of which flap is appropriate for the reconstruction of soft tissue defects of the nose.

Framework fabrication with rib cartilage in partial and total nasal reconstruction.

The framework reconstruction of the nose is a significant and complex component of its partial or total reconstruction. On the one hand, the design of the individual framework parts is based on the anatomic nature of available rib or ear cartilage, which must on the other hand be adapted to the anatomic characteristics of the defect. The framework parts must be anchored not only to each other but also stably to the facial skeleton. The symmetry of the framework reconstruction is an essential component of the aesthetics of the reconstructed nose. If these points are already considered in planning, the reconstruction of the nasal framework can be standardized insofar as the same principles for the basic design of the individual parts as well as stable solutions for the anchoring points can be chosen. With reproducible techniques, functionally and aesthetically good to very good results can be achieved, including in the long term. The surgeon must possess special skills in the field of nasal reconstruction to correctly choose, apply, and combine the various techniques of nasal framework reconstruction.

Nasal reconstruction in heminasal deficiency (proboscis lateralis): two case reports, with airway reconstruction in one case.

Proboscis lateralis is a very rare congenital malformation with heminasal hypoplasia or aplasia. The affected side is represented by a trunk (proboscis) which can be positioned from the upper eyelid down to the alar base. We present two cases of proboscis lateralis, one in which we reconstructed an airway. The first case is a 16-year-old male patient who presented with heminasal aplasia. Immediately after birth, a proboscis lateralis was resected from the right upper eyelid as primary treatment elsewhere. We reconstructed the nose using costal cartilage as framework. A paramedian forehead flap was transposed to give the patient a nose with adult dimensions. We made no attempt to reconstruct an airway in this case as unilateral nasal breathing appeared adequate. The second case is a 14-year-old male patient who presented with heminasal aplasia on his right side, where a nodule-like appendix was existent with a fistula underneath. A computed tomographic scan revealed an existing hypoplastic posterior nasal airway and a complete ventilated sinus system. The fact that there was an existing posterior airway encouraged us to construct an anterior airway to create an airflow passage. Costal cartilage was taken for framework reconstruction and nasal skin was completely replaced by a paramedian forehead flap. The reconstructed airflow passage was stable.