Reconstruction of composite defects of the nose following tumor resection — a single author’s experience and evaluation of the outcome

Abstract

The aim of the study was to present our experience in reconstruction of complex defects of the nose. Fourteen patients presenting with large composite defects of the nose were anatomically reconstructed after full tumor clearance of a skin cancer. The aesthetic outcome was assessed subjectively and objectively while the functional outcome was only assessed subjectively in 13 patients. Basal cell carcinoma (BCC), represented the tumor excised in 10 patients while the remaining 4 patients suffered from squamous cell carcinoma (SCC). One patient died of extensive local recurrence of SCC after 6 months. The commonest flap used for inner lining was the septal flap while the forehead paramedian flap provided the external coverage for the majority of patients. All flaps survived completely except in one patient who developed distal paramedian forehead flap necrosis. Two patients developed multiple abscesses and sinuses discharging parts of cartilage grafts through the flaps’ skin with one patient suffering from total extrusion of the costal cartilage grafts. Two other patients suffered from severe nostril stenosis. All patients had variable degree of difficulty in airway passage, while most patients were satisfied with the total nasal appearance. The objective assessment of the overall appearance of the nose scored less than the subjective satisfaction. Reconstruction of complex nasal defects has a high learning curve. Intranasal flaps are usually of limited size and nostril asymmetry is likely to occur. Local or regional skin flaps if available are still considered a good choice for inner as well as outer lining.