Nasal Tip Defects Research Articles

Split Dorsal Nasal Flap: A Modification to Expand Its Utilization.

Nasal reconstruction presents the facial plastic surgeon with a complex problem given its functional and aesthetic importance. The dorsal nasal flap is a composite rotational flap of the glabella and nasal dorsum that can be used for nasal dorsum and tip defects of medium to large sizes. Given its composite nature, this flap can be split into its constituent parts-the epidermis and dermis and the subcutaneous tissue and superficial musculoaponeurotic system-without flap loss. This case series describes this technique and various potential applications within nasal reconstruction.

Algorithm for the Treatment ofTip Malformation Combining a Clinical Qualitative Assessment and Specific Closed-Rhinoplasty Techniques Based on Retrospective Analysis of Pellegrini's Fellows 40 Years' Experience.

The aesthetic importance of nasal tip and the complexity of its surgical correction make the surgery of this area one of the most fascinating facial surgical procedures. Despite description of different sculpturing techniques to correct nasal tip defects, this surgery remains one of the most discussed and challenging aesthetic procedures. The objective of this study was to define an algorithm of treatment for nasal tip surgery based on 40-year experience on Caucasian patients evaluated by our proposed clinical qualitative assessment, who were treated by closed rhinoplasty. We retrospectively reviewed 19,643 Caucasian patients (15,266 females and 4,377 males) who underwent primary closed rhinoplasty from 1979 to 2019 due to different tip defects. The patients were evaluated by volume projection rotation (VPR) assessment. The surgical indications options, long-term aesthetic results and complications were analysed. 22% patients with minimal nasal defects were treated by non-delivery approach and 78% patients with important tip malformation by delivery approach. In all cases, the surgery was performed to reduce tip volume and modify tip projection and rotation based on the specific nasal defects. 67% patients, who needed important reduction of tip projection, were treated by tip-interrupting techniques. 88.7% patientsdeclared full satisfaction after surgery,and only 12.3% needed a requiring minor revision surgery during the 20 years follow-up. The proposed algorithm may be a useful tool to plan surgery. The use of an adequate technique depending on the evaluation of volume, projection and rotation may guarantee higher patients satisfaction and a stable long-term aesthetic result. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Horn Flap outcome in the nasal tip defect: Evaluation of postoperative scarring through patient and observer scar assessment scale score

The Horn Flap outcome in the nasal tip defect: Evaluation of postoperative scarring through patient and observer scar assessment scale score

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction.

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction.

Classification and a decade-long follow-up of rat bite injuries in the nasal region

BackgroundNasal defects due to rat bites are frequently encountered in rural regions of China. In addition to serving as disease vectors, rats can also inflict bite injuries. In this study, we delineated the characteristics of rat bite injuries in the nasal region and discussed the clinical features observed during a 10-year follow-up period. MethodsWe retrospectively reviewed hospital records for patients admitted due to rat bites. This study outlines the demographics, clinical features, and follow-up outcomes supported by comprehensive photo documentation of the patients’ progress. ResultsTwenty-five patients, with a mean age of 29 years, were admitted due to rat bites. Treatment was provided for three distinct types of injuries: nasal tip defect (type I), nasal defect (type II), and full-thickness nasal defect with loss of surrounding tissues (type III). All patients recovered fully. ConclusionsThe treatment for rat bites should be based on the wound type. The long-term follow-up outcomes are more favorable when fewer subunits of the nose affected. We recommend early surgical intervention, along with psychological therapy, to prevent interference with growth and development.

Over-rotated Rieger flap for a large lateral nasal tip defect reconstruction

A 65-year-old man presented with a Melanoma in situ of the nasal tip. Complete excision was achieved after 2 “Slow Mohs” stages, resulting in a circular 2.7 X 2.4 cm defect involving the right lateral nasal tip, dorsum and sidewall and extending to the perichondrium.

Süreyya-Dani technique, a new technique to address notching of soft triangle and opening external nasal valve.

While different methods are employed for fixing narrowed nasal valves and preventing the notching of soft triangles, this study aims to demonstrate the effectiveness of a new technique called Süreyya-Dani Technique. This prospective study composed 100 patients who underwent rhinoplasty using the Süreyya-Dani technique. All patients presented with either notching of the soft triangle and/or external nasal valve dysfunction. Patients with the absence of soft triangle notching and external nasal valve dysfunction were excluded from this study. Facial analysis was conducted for all patients to identify any asymmetry in the face, and all nasal defects were identified. Descriptive statistics were calculated for different variables. Analytical statistics, namely Chi-Square test, was conducted with a significance level set at P < 0.05. In the current study, 100 patients were involved, out of which 63 (63%) were female and 37 (37%) were male. The participants' ages ranged from 18 to 46 years, with a mean age of 30 years. various chief complaints were found among patients, with the majority 37(37%) expressing cosmetic concerns. A statistically significant difference was found for the association of nasal tip defects with genders, intraoperative findings, and chef complaints, and the association between the degree of external valve insufficiency and crural weakness (P-value < 0.05). Despite many techniques that have been put forward to fix narrowed nasal valves and prevent notching of the soft triangle, the Süreyya-Dani Technique could work to prevent its occurrence successfully.

Reconstruction of a Nasal Tip Defect.

Reconstruction of a Nasal Tip Defect.

Valsalva Maneuver to Identify Dermal Bleeders after Paramedian Flap Elevation Under Local Anesthesia.

The paramedian forehead flap (PFF) provides a reliable reconstruction option for complex nasal tip defects. The robust blood supply from a well perfused pedicle allows for reconstruction of large defects of the nasal tip for which simpler methods/techniques would provide inadequate coverage or result in inferior cosmesis. A well-designed PFF containing the supratrochlear artery inherently predisposes to small vessel bleeding from the pedicles cut edge. Due to the well perfused nature of the pedicle, there is an increased risk of post-operative bleeding. We describe a technique for better identifying bleeding points from the pedicle to optimise intra-operative haemostasis by performing the Valsalva maneuver using a syringe intraoperatively.

Repair of a Nasal Tip Defect.

*All authors are affiliated with the Division of Dermatology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York Address correspondence and reprint requests to: David H. Ciocon, MD, Mohs Micrographic Surgery and Procedural Dermatology at the Montefiore Medical Center, Albert Einstein College of Medicine, 3411 Wayne Avenue 2nd Floor, Bronx, NY 10467, or e-mail: [email protected] The authors have indicated no significant interest with commercial supporters.

Reconstruction of Nasal Alar and Tip Defect.

*Department of Dermatology, The Royal Melbourne Hospital, Parkville, VIC, Australia; †Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; and ‡The Skin Hospital, Darlinghurst, NSW, Australia Address correspondence and reprint requests to: Hnin Pwint Oo, MD, Department of Dermatology, The Royal Melbourne Hospital, Level 8, CMR Building, 300 Grattan Street, Parkville, VIC3050, Australia, or e-mail: [email protected] The authors have indicated no significant interest with commercial supporters. The Skin Hospital, 121 Crown Street, Darlinghurst, New South Wales, Australia 2010.

Superior Antihelix Composite Graft for Repair of Nasal Ala and Lateral Nasal Tip Defects: A Retrospective Case Series.

Deep defects on the nasal ala and lateral nasal tip may result in nasal valve insufficiency or alar notching and are often repaired with a 2-stage reconstruction. Previous literature has demonstrated high failure rates of composite grafts. Identify survival rates and cosmetic outcomes of nasal composite grafts harvested from the antihelix. A retrospective review of 52 patients who underwent ala or lateral nasal tip composite graft repair from April 2019 through May 2022, with statistical analysis of cosmetic outcomes graded by 2 surgeons. Defect size ranged from 0.7 cm × 0.8 cm to 1.9 cm × 2.5 cm. 48 grafts survived (92.3% survival rate). Four patients sustained at least partial integument sloughing (epidermal necrosis), but the cartilage survived in all 52 cases. Overall, aesthetic results yielded the following: excellent (19.5%), very good (35.5%), good (11.5%), decent (16.5%), and poor (6%). In 93% of cases, there was no evidence of nasal collapse or retraction. Two patients (3.8%) required surgical revision. Donor site morbidity was low. The antihelical composite skin graft is a 1-step reliable repair option for ala and lateral nasal tip defects with an acceptable cosmetic outcome.

Secondary Intention Healing of Nasal Ala and Tip Defects: A Simple and Valuable Treatment Option.

PurposeTo investigate the cosmetic outcomes of secondary intention healing of small (<1.5cm) nasal ala and tip defects.Patients and MethodsFrom August 2017 to October 2020, 42 patients with nasal reconstructions using secondary intention healing were included. Defects after excision ranged from 0.5cm×0.7cm to 1.2cm×1.5cm in size. Foam dressing covering the wounds was changed every 3 to 5 days. Wound esthetic outcomes were graded as excellent, good, acceptable, and poor based on definitions described in the literature.ResultsAll 42 wounds healed in 3 to 4 weeks, with uniform color, no obvious adverse reactions and high patient satisfaction. Esthetic evaluation: 16 excellent cases (38.1%), 19 good cases (45.2%), 7 acceptable cases (16.7%) and 0 poor cases.ConclusionSecondary intention healing of small nasal tip and ala defects in Chinese yielded satisfactory esthetic outcomes and should be an integral part of the surgeon’s reconstructive algorithm.

Post dermoid excision nasal tip deformity correction using gelatin sponge.

Reconstruction of the nasal tip after the excision of the dermoid cyst is difficult, especially if the size of the dermoid is large. Tip reconstruction using Interdomal sutures of alar cartilages and auricular cartilage graft has been used in such cases. We share a new method to manage the nasal tip defect following excision of nasal dermoid, using an absorbable gelatin sponge. A 13 years old female presented with a swelling tip of the nose for the past 2 years. The CT scan revealed a dermoid cyst at the tip of the nose over the alar cartilage with prominent buckling of the cartilages. The Dermoid cyst was excised through an open rhinoplasty incision. There was a defect of 2.2cm diameter at the tip of the nose with deformed alar cartilages. A piece of absorbable gelatin sponge was folded, cut according to the shape of the cavity, and used to fill the cavity. The skin was draped over the cartilage and gelatin sponge. The post-operative period was uneventful. After 2 years of follow-up, the patient remained asymptomatic and satisfied with a nice contour of the nasal tip.

Evaluation of Modified Dorsonasal Flap for Reconstruction of Dorsonasal Defect in Erbil

Background and objectives: nasal reconstruction is challenging for plastic surgeons mainly because its midfacial location and the relationship between convexities and concavities of nasal subunits that make it difficult to hide any contour deformity; as a result, proper planning of final scar location is crucial for successful aesthetic outcome. The modified dorsal nasal flap is used for resurfacing nasal tip defects with respecting of these nasal subunits. This paper evaluates the outcome of modified dorsonasal flap for reconstruction of the dorsal nasal defects. Method: in our department twenty nasal defects were reconstructed with modified dorsal nasal flap between years (2016-2019); Charts of these patients were analyzed in relation to their age, cause and size of the defect, complications and appearance. Results: half of patients who underwent nasal reconstruction by dorsal nasal flap were males (n=10) and the other half were females (n=10), mean age 39.5 months, median defect diameter was (21mm), follow up period ranged from (7-42 months), all patients were satisfied with results with no significant complications including: hematoma, infection, flap loss or wound dehiscence. Conclusion: Dorsal nasal flap is reproducible one stage flap for reconstruction of nasal defects with minimal complication and good aesthetic outcome.

Nasal tip defects: satisfaction with Rintala flap for reconstruction—a report of 38 cases

Nasal tip defects: satisfaction with Rintala flap for reconstruction—a report of 38 cases

“THUNDER – LIKE” PLASTY FOR TWIN NASAL TIP DEFECTS. TECHNIQUE DESCRIPTION AND INDICATIONS

​INTRODUCTION: Reconstructive approaches to nasal tip defects are always challenging to perform, depending on the age of the patient, shape of the nose, local anatomy and adjacent structures. Many techniques have been described, each one with its advantages and limitations. AIM: Our aim is a new technique description designed for the reconstruction of twin defects of the nasal tip. The decision-making, the step-by-step description, and its application to a male patient are explained in detail. MATERIAL - METHOD: A 61 years old male patient was referred to our department with two benign lesions of the nasal tip. Due to their proximity, a simultaneous excision was planned in a way that allowed both adequate excision and minor defect dimensions. The remaining defect was reconstructed with a combination of 2 rotation flaps and 2 V-Y plasties. RESULTS: Very good skin match (color and texture). Suture lines are barely detectable because they are buried in the anatomical border between the nasal tip and the alar area. No consequences for the alar shape or the columella are mentioned (deviation, stricture, narrowing or flattening respectively). CONCLUSION: This technique has been influenced by the “East – West plasty”. Its innovative elements are: 1. The upper triangle hereafter contains the second lesion. 2. The V-Y plasties we intendedly added on top of each rotation flap limit loss of length resulting in well aligned scars. The technique is advisable for benign lesions, in situ malignancies or for centers performing Mohs micrographic surgery.

28284 Subcutaneous hinge flaps: A great choice, especially in the setting of COVID

A 55-year-old woman presented for Mohs surgery with an infiltrative basal cell carcinoma of the nasal dorsum with a preoperative size of 0.9 cm × 0.7 cm. Negative margins were achieved after five stages, and the resultant defect measured 2.6 × 2.4 cm with exposed cartilage and involvement of 4 subunits of the nose (Figure 1). For large nasal tip defects, a paramedian forehead flap (PMFF) is nearly the gold standard. These flaps are chosen due to good color match between the donor forehead skin and the nose, the presence of sebaceous tissue within the flap, and the ability to match the flap depth to the depth of the defect. Our patient was offered a paramedian forehead flap and adamantly declined, citing her inability to care for the flap. Instead, she elected for a two-stage repair of a subcutaneous hinge flap from the upper nasal dorsum to restore the contour and depth of the nasal tip and supratip, to cover the exposed cartilage, and to provide good blood supply for the subsequent full thickness skin graft performed during the second stage of repair. She had excellent take of the FTSG and was pleased with her result. Several months after the surgery, the area was lightly dermabraded and then treated with several pulse dye laser treatments with good cosmesis. This repair option is especially important during COVID times, when a PMFF would minimize the ability to function in society and to safely wear a mask.

Double-semicircular skin graft: A method to minimize wasted donor tissue

Donor site selection is very important when using a full-thickness skin graft (FTSG) in reconstructive surgery of nasal defects.1 The nasal root has been suggested as an excellent donor site for nasal tip defects because of the similarity in its color, texture, thickness, degree of actinic damage, and sebaceous quality.2 An elliptical excision is often used for harvesting an FTSG where tissues on both sides of the donor skin are discarded. However, since a larger donor area is required for large defects, using the conventional elliptical FTSG from the nasal root was challenging to repair a large nasal tip defect after wide excision of an 8 × 7-mm–sized basal cell carcinoma with a 4-mm margin (Fig 1, A).

Combination of Extended Paramedian Forehead Flap and Laser Hair Removal in the Reconstruction of Distal Nasal Defect.

The study sought to determine whether extended forehead flap by using part of the scalp combined with laser hair removal is a practical approach when repairing distal nasal defect. A retrospective study was conducted with 6 patients who underwent reconstruction of nasal defects with extended forehead flaps (including scalp combined with subsequent laser hair removal) at Shanghai Ninth People's Hospital between June 2016 and December 2018. Surgical data collected included age, causes of defects, sizes of defects, invaded nasal subunits, implantation of tissue expander, time elapsed between the formation of defects and surgical treatments, sessions of laser hair removal, and follow-up results. All patients had nasal defects after removal of a benign nevus (diameter, >1.5 cm), which invaded distal nasal subunits (including the nasal tip, soft triangle, columella, and nasal ala) and could not be repaired using adjacent tissue. Preoperative and postoperative assessments of esthetic outcomes were analyzed, including skin color and texture match, appearance deformity, and scar appearance. All 6 female patients (ages 4 to 24 years) accepted the extended forehead flap technique and subsequent laser hair removal treatments. Among the 6 patients, 2 had nasal tip defects, 1 had a columella nasi defect, one had an alar defect, and 2 had multiunit defects. All transferred forehead flaps survived with no necrosis and underwent 2 to 5 subsequent laser hair removal treatments. The color and texture of the transferred flaps was similar to the adjacent skin in all patients. All patients were satisfied with the final outcome of the reconstructed nose with no obvious scarring during follow-up. Extending the forehead flap using the scalp is a practical and safe approach for the repair of large and distal nasal defects. Subsequent laser hair removal can eliminate the hair follicles of the scalp and improve the appearance and color of the flap.