Nose is one of the very specialized units of the face both cosmetically and functionally. Any defect of the nose causes disfigurement and significant functional problems. 

Reconstruction of the nose is very important and is required when there is a defect either due to trauma, infection, birth defects or removal of lesion. 

When there is loss of nasal tissue due to trauma or infection or any lesion (by birth or tumor) is removed from it leaves a defect which needs to be filled according to its size and depth.  If not reconstructed properly it causes unsightly scar, depressions, and functional problems. 

Small defects of less than 1 cm can be closed primarily. Larger defects require local flap or regional flap or free flap. 

Nose has special subunits which give the nose its unique appearance and failure to reconstruct them properly results in ugly appearance. Complex defects of the nose require staged surgeries to give good results. 

Forehead flap is the most commonly used flap for complex nasal defects. Design of the defect is made on the forehead of the patient and the flap is transferred to the nose with its blood supply intact. Cartilage or bone graft from ear nose or chest wall is used to reconstruct differ subunits then forehead flap is placed over it. Flap is attached with a ridge of skin which is divided in 3 weeks. Sometimes a 3rd stage is also required for final finishing. More complex defects are reconstructed with free tissue transfer from distant parts of the body along with cartilage or bone grafts.

FAQ

1.How much time nasal reconstruction require?

Simple reconstructions with skin graft or local flaps are done in one our time, regional flap with cartilage or bone grafts takes 3-4 hours and free flaps require 6-8 hours

2.How many days of hospitalization is required?

Simple procedures for small defects are done as day care, larger lesions require hospitalization for 4-5 days.

3. What are options if the nose is not reconstructed with surgery?

There is option of nasal prosthesis (custom made nose with artificial material placed over healed area of defect)

Written by :  Dr. Fahmina

Copyrights: Pakistan association of Plastic Surgeons