Publication:

Reconstruction of nasal defects with local flaps

Background Nasal reconstruction was among the earliest plastic surgical procedures performed. Mutilation of noses as a result of trauma, infection or tumor is a problem since antiquity. Skin cancer is the most common human malignancy. Various techniques of nasal reconstruction are mentioned in the literature includes healing by secondary intent, dermabrasion, primary closure, full thickness skin grafts composite grafts, local flaps and free flaps. This study was done to document the various causes of nasal defects and outcome of nasal reconstruction with local flaps.

Methods It was a prospective study done from August 2011 to August 2014 conducted at Bangalore Medical College and Research Institute. A total of 41 patients having a nasal defects were included in study. Age: 5-70 years. With mean age of 44 years. The following procedures were done in the study: forehead flap (pre-laminated forehead flap was done in 2 patients.) Nasolabial, bilobed flap, dorsum nasal dorsum glabella flap, free helical graft, cheek advancement flap.

Results The etiology of nasal defects included 27 patients with skin malignancy, 11 patients due to trauma, 2 patients due to infection,1 patient of electrical burns and 1 patient of heamangioma. Nasal defects seen were columella defects in 3 patients ,subtotal nose loss in 3 patients, alar defects in 9 patients, tip, supratip and soft triangle defects in 15 patients , dorsum of nose defects in 8 patients and total nose loss in 3 patients. The reconstruction of the nose defects were done using forehead flap in 20 patients, nasolabial flap in 11 patient, bilobed flap in 4 patients, dorsum nasal flap in 2 patients, free helical graft in 2 patients, cheek advancement flap in 2 patients.

Conclusions In our study, malignancy is the most common cause of nasal defect flowed by trauma. We conclude that nasolabial flap is flap of choice for small size defects with minimal donor morbity. Moderate to big defects, prelaminated forehead is the best option.