Reconstruction Of Nose Research Articles

Current strategies for aesthetic soft tissue refinement in nasal reconstruction.

The challenges of successful nasal reconstruction, which are related to the anatomical complexity of the region, have been extensively studied. Revisional operations are often required to achieve proper nasal reconstruction, with results resembling the premorbid nasal status. This is necessary to ensure the quality of life of skin cancer patients. Fundamental nasal reconstruction requires both proper soft tissue coverage and proper function. However, earlier studies in the field primarily focused on the functional aspect of nose reconstruction, although the cosmetic aspect is also an important factor to consider. In response to this need, many recent studies on nose reconstruction have proposed various refinement strategies to improve aesthetic satisfaction. Most plastic surgeons accept the nasal aesthetic subunit principle as a standard for nasal reconstruction. This review outlines the commonly used surgical refinement options and management strategies for postoperative complications based on the subunit principle. In patients with nasal defects, a proper technical strategy might help minimize revision operations and optimize the long-term results.

Paramedian Forehead Flap for Nasal Tip Reconstruction Related to Barbed Suture Infection

Introduction : The nasal tip abscess is a rare pathology that affects the soft tissue of the nasal tip, with risk of damaging the cartilaginous framework with the resulting alteration of the anatomy and function of the nose, if not treated properly.Case Presentation : A 22-year old female patient developed progressive defect with pain sensation at her nasal tip after bumping her nose 2 months ago and she admitted that she underwent a thread rhinoplasty 1 year ago. The reconstructive surgery was performed by excision of the ulcer, threads evacuation, and closing the defect with paramedian forehead flap procedure.Summary: In this case, the problem can be treated very well with the paramedian forehead flap procedure which is an excellent option for nose reconstruction.

Development of a questionnaire for a patient-reported outcome after nasal reconstruction.

Our face plays an important role in communication and social life. Defects of the face have abig impact on socializing and psychics of patients with its deformities. Agood esthetic outcome is an important task of each reconstructive surgery. With amodern concept of nose reconstruction, it is possible to achieve abetter esthetic and functional outcome than it was possible with one phase reconstructions before. There was a specific tool missing to measure patients reported outcome and objectively evaluate benefits of nose reconstruction from a patients point of view and get reliable feedback about the whole procedure. The goal of this paper is to develop such aquestionnaire. Apilot questionnaire was developed with literature input. The questionnaire was tested on five patients. Based on patients feedback and a review from a psychologist, thesecond version of the questionnaire was made. It was sent to 39 patients, who underwent nose reconstruction in the years 2016-2020. After two appeals, 34 completed questionnaires were sent back (87,2%). The final version of the questionnaire was developed after athorough mathematic and statistical analysis of collected data. The group of patients who completed the questionnaire consisted of 16 females (47%) and 18 males (53%). On average, the patients were 69 years old (17-88 years). The final questionnaire is structured into six categories from Ato F: A- general information defining the patient and purpose for reconstruction, B - satisfaction with esthetic outcome, C - satisfaction with function and stability, D - satisfaction with medical treatment, E - social and psychological impact, F - overall satisfaction. Most of the questions use a5-point rating scale. The questionnaire enables the patients to provide feedback on particular aspects of the treatment and their overall satisfaction with the whole procedure and its outcome. With statistical analysis, it is possible to discover specific treatment aspects that have crucial impact on overall satisfaction with the whole procedure. Apatient-reported outcome helps to improve the quality of provided health care and the quality of patient life.

Опыт реконструкции облика человека раннего неолита из погребения могильника Шумилиха (Южное Приангарье)

This paper presents the results of a reconstruction of the appearance of a hunter-gatherer of the Kitoi culture from a burial at the Shumilikha cemetery in the Southern Angara region. The excavations were carried out in 1999. In the grave, the walls of which were coated with clay, the remains of a human 25–35 years old were found. Under the skeleton, which was sprinkled with “ocher” (grated hematite rock), traces of a wooden construction were recorded. The grave goods (more than a hundred items) included such interesting finds as the kernels of fishhooks, a bone spoon, beads made of bone paste, as well as two items made of white jade: a ring and a cylindrical bead. There is a reliable radiocarbon date for the human bone, which, taking into account the correction for the reservoir effect, shows an age of 7,003±106 cal BP and allows you to determine the age of this complex by the Early Neolithic. Modern software for 3D modeling and visualization opens up great opportunities, so a virtual method was chosen to reconstruct the appearance of a human from a burial. First, all the bones of the skeleton were scanned, for which two types of 3D equipment were used: a stationary scanner RangeVision Spectrum based on structured light photogrammetry (for the skull and small bones) and a hybrid handheld scanner with structured LED and infrared illumination Shining 3D Einscan H (for large bones). The scan results are processed in RangeVision's ScanCenter NG using built-in algorithms. Filling voids, smoothing surfaces, simplifying 3D models, and correcting mesh defects are done manually at the stage of model postprocessing. For further work, the resulting models were transferred to the stl format. Facial reconstruction was carried out in Blender and ZBrush in several stages: 1) importing and combining models; 2) modeling of lost teeth and reconstruction of the occlusion; 3) CAD modeling of a set of soft tissue depth markers and their positioning by craniometric points; 4) modeling of auxiliary circuits for nose reconstruction and eyeball setting; 5) modeling of masticatory muscles; 6) modeling of facial muscles and fat sacs to simplify the production of a basic head model; 7) modeling the base mesh of the head; 8) digital sculpting of the head; 9) detailing of the digital sculpture; 10) rendering of the model and preparing the model for printing. As a result, a digital model of the appearance of an Early Neolithic hunter-gatherer from a burial at the Shumilikha cemetery was obtained.

Опыт реконструкции облика человека раннего неолита из погребения могильника Шумилиха (Южное Приангарье)

This paper presents the results of a reconstruction of the appearance of a hunter-gatherer of the Kitoi culture from a burial at the Shumilikha cemetery in the Southern Angara region. The excavations were carried out in 1999. In the grave, the walls of which were coated with clay, the remains of a human 25–35 years old were found. Under the skeleton, which was sprinkled with “ocher” (grated hematite rock), traces of a wooden construction were recorded. The grave goods (more than a hundred items) included such interesting finds as the kernels of fishhooks, a bone spoon, beads made of bone paste, as well as two items made of white jade: a ring and a cylindrical bead. There is a reliable radiocarbon date for the human bone, which, taking into account the correction for the reservoir effect, shows an age of 7,003±106 cal BP and allows you to determine the age of this complex by the Early Neolithic. Modern software for 3D modeling and visualization opens up great opportunities, so a virtual method was chosen to reconstruct the appearance of a human from a burial. First, all the bones of the skeleton were scanned, for which two types of 3D equipment were used: a stationary scanner RangeVision Spectrum based on structured light photogrammetry (for the skull and small bones) and a hybrid handheld scanner with structured LED and infrared illumination Shining 3D Einscan H (for large bones). The scan results are processed in RangeVision's ScanCenter NG using built-in algorithms. Filling voids, smoothing surfaces, simplifying 3D models, and correcting mesh defects are done manually at the stage of model postprocessing. For further work, the resulting models were transferred to the stl format. Facial reconstruction was carried out in Blender and ZBrush in several stages: 1) importing and combining models; 2) modeling of lost teeth and reconstruction of the occlusion; 3) CAD modeling of a set of soft tissue depth markers and their positioning by craniometric points; 4) modeling of auxiliary circuits for nose reconstruction and eyeball setting; 5) modeling of masticatory muscles; 6) modeling of facial muscles and fat sacs to simplify the production of a basic head model; 7) modeling the base mesh of the head; 8) digital sculpting of the head; 9) detailing of the digital sculpture; 10) rendering of the model and preparing the model for printing. As a result, a digital model of the appearance of an Early Neolithic hunter-gatherer from a burial at the Shumilikha cemetery was obtained.

3D corrective nose reconstruction from a single image

There is a steadily growing range of applications that can benefit from facial reconstruction techniques, leading to an increasing demand for reconstruction of high-quality 3D face models. While it is an important expressive part of the human face, the nose has received less attention than other expressive regions in the face reconstruction literature. When applying existing reconstruction methods to facial images, the reconstructed nose models are often inconsistent with the desired shape and expression. In this paper, we propose a coarse-to-fine 3D nose reconstruction and correction pipeline to build a nose model from a single image, where 3D and 2D nose curve correspondences are adaptively updated and refined. We first correct the reconstruction result coarsely using constraints of 3D-2D sparse landmark correspondences, and then heuristically update a dense 3D-2D curve correspondence based on the coarsely corrected result. A final refinement step is performed to correct the shape based on the updated 3D-2D dense curve constraints. Experimental results show the advantages of our method for 3D nose reconstruction over existing methods.

Arhinia and Bilateral Anophthalmia: Report of a Rare Case and Review of Literature

Arhinia is an extremely rare condition reported in less than 100 cases so far. We report a case of arhinia with bilateral anophthalmia. In physical examination, only alar portions of the nose were partially formed. No septal, lower, upper lateral cartilages or nasal bones were detectable. Both nostrils were atretic. The orbital area was covered with skin, and eyebrows were partially formed. Bilateral complete cleft lip and palate were evident. Surgical interventions should be considered not only for reconstruction of the external nose but for timely creation of a lacrimal passage and repair of the accompanying cleft lip and palate.

Reconstruction of Nose and Adjacent Facial Units With Chimeric Flap Combined of Auricular Free Flap and Radial Forearm Free Flap.

Composite full-thickness nasal defects that include adjacent facial units still remain a challenge for reconstructive surgeons. The commonly used auricular free flap (AFF) might not be sufficient for full coverage of a defect, and radial forearm free flap (RFFF) lacks the rigid component for nasal framework. Therefore, the authors present a chimeric flap combined of both AFF and RFFF for the reconstruction of extended nasal defects. Auricular free flap enables the restoration of the exact contour of nose, and it preserves similar texture and color of the skin. Moreover, its harvesting results in minimal deformity of donor site. Radial forearm free flap gives the possibility of covering extensive defects of the facial units thanks to its elasticity and long vascular pedicle. The combination of both flaps seems to be an optimal solution for the reconstruction of extended nasal defects, giving satisfactory aesthetic results. Also, it might not require any further corrections, remaining a one-stage procedure.

Upper Margin of the Forehead Flap and Its Correlation With Aesthetic Results in Nasal Reconstruction in Fitzpatrick Skin Type III and IV Chinese.

The forehead flap is one of the most commonly used methods for nose reconstruction. To determine the ideal upper margin of the flap in nasal reconstruction and its correlation with aesthetic results. From April 2013 to September 2017, 40 patients underwent nasal reconstruction involving the dorsum with a forehead flap. The authors hypothesized 5fdifferent levels as the position to place the upper margin of the forehead flap: (1) glabella, (2) level of the upper eyelid, (3) intercanthal line, (4) horizontal line between the keystone and intercanthal line, and (5) the keystone. Then they photoshopped the upper margins of the forehead flap at 5 different levels and designed a questionnaire. Nasal reconstructive plastic surgeons, medical practitioners, and people without medical backgrounds chose the most aesthetically pleasing photograph for every patient. The questionnaire showed that the most aesthetically pleasing positions were located at glabella (n = 0), level of upper eyelid (n = 9), intercanthal line (n = 24), the line between keystone and intercanthal line (n = 6), and keystone (n = 1). The authors suggest placing the upper margin of the forehead flap at the level of the intercanthal line in nasal reconstruction involving the dorsum to achieve the best aesthetic results.

State of the Art of Clinical Applications of Tissue Engineering in 2021.

Tissue engineering (TE) was introduced almost 30 years ago as a potential technique for regenerating human tissues. However, despite promising laboratory findings, the complexity of the human body, scientific hurdles, and lack of persistent long-term funding still hamper its translation toward clinical applications. In this report, we compile an inventory of clinically applied TE medical products relevant to surgery. A review of the literature, including articles published within the period from 1991 to 2020, was performed according to the PRISMA protocol, using databanks PubMed, Cochrane Library, Web of Science, and Clinicaltrials.gov. We identified 1039 full-length articles as eligible; owing to the scarcity of clinical, randomized, controlled trials and case studies, we extended our search toward a broad surgical spectrum. Forty articles involved clinical TE studies. Among these, seven were related to TE protocols for cartilage applied in the reconstruction of nose, ear, and trachea. Nine articles reported TE protocols for articular cartilage, nine for urological purposes, seven described TE strategies for cardiovascular aims, and eight for dermal applications. However, only two clinical studies reported on three-dimensional (3D) and functional long-lasting TE constructs. The concept of generating 3D TE constructs and organs based on autologous molecules and cells is intriguing and promising. The first translational tissue-engineered products and techniques have been clinically implemented. However, despite the 30 years of research and development in this field, TE is still in its clinical infancy. Multiple experimental, ethical, budgetary, and regulatory difficulties hinder its rapid translation. Nevertheless, the first clinical applications show great promise and indicate that the translation toward clinical medical implementation has finally started. Impact statement The clinical use of a tissue-engineered windpipe in compassionate patients elicited euphoria in the media between 2010 and 2016: tissue engineering (TE) had proven to be no longer a fictional concept but a life-saving reality. However, most of the treated patients died, and the surgeon was convicted for scientific misconduct and aggravated assault. As of 2020, the authors had eight of their articles retracted and two received an expression of concern.1 These events have fueled skepticism among clinicians about TE: science or fiction? Although TE is full of promises, it is not realistic yet to engineer a (vascularized) construct that thrives in a "hostile" clinical environment. Therefore, a realistic update of the current clinical outcomes and the promises of TE in human trials are essential.

Angiosarcoma of the Nose: A Case Report and Review of the Literature

Angiosarcoma is a rare and aggressive type of neoplasm that develops in the inner lining of blood vessels and lymph nodes. It accounts for less than 0.1% of head and neck malignancies. The treatment is based on surgery followed by wide field radiotherapy. Anyhow, the risk of local failure and recurrence as well as distant relapse remains high for this disease. We present in this paper a 55-year-old male patient case, with no significant medical history, who was referred for the evaluation of an erythematous and indurated plaque of 2.5 cm in the bridge of the nose. The physical exam showed no head or neck lymphadenopathy, and no nasal or oral mucosal involvement were noted. Multiple biopsies of the nose were taken, and the diagnosis of the specimens was angiosarcoma. MRI showed only soft tissues involvement and no distant metastasis were found on the CT scans. The patient was subsequently treated with total rhinectomy followed by total nose reconstruction. Thus, angiosarcoma of the nose is an uncommon pathology and it should be rapidly diagnosed. A delay in the diagnosis could result in significant therapeutic challenges. Surgery and postoperative radiotherapy are the two pillars of treatment.

The Performance of Secondary Nasal Alar Base Revision for Unilateral Cleft Lip by Single YV-Plasty (the Importance of Overcorrection During Surgery).

Although primary surgery for cleft lip has improved over time, the degree of secondary cleft or nasal deformity reportedly varies from a minimum degree to a remarkable degree. Patients with cleft often worry about residual nose deformity, such as a displaced columella, a broad nasal floor, and a deviation of the alar base on the cleft side. Some of the factors that occur in association with secondary cleft or nasal deformity include a deviation of the anterior nasal spine, a deflected septum, a deficiency of the orbicularis muscle, and a lack of bone underlying the nose. Secondary cleft and nasal deformity can result from incomplete muscle repair at the primary cleft operation. Therefore, surgeons should manage patients individually and deal with various deformities by performing appropriate surgery on a case-by-case basis. In this report, we applied the simple method of single VY-plasty on the nasal floor to a patient with unilateral cleft to revise the alar base on the cleft side. We adopted this approach to achieve overcorrection on the cleft side during surgery, which helped maintain the appropriate position of the alar base and ultimately balanced the nose foramen at 13 months after the operation. It was also possible to complement the height of the nasal floor without a bone graft. We believe that this approach will prove useful for managing cases with a broad and low nasal floor, thereby enabling the reconstruction of a well-balanced nose.

Is reconstruction of composite defects of nose and cheek following tumor excision utilizing subunit principle the best?

<p class="abstract"><strong>Background:</strong> Composite defects of nose and cheek are best stage reconstructed with separate nose and cheek flaps to recreate a blended nose-cheek junction, achieved by cheek advancement flap for cheek and forehead flap or local grafts for the nasal defect. This article analyses whether reconstruction of defects utilizing well-known subunit principle is cosmetically the best?</p><p class="abstract"><strong>Methods:</strong> Case records of fifteen patients of nasal cancers extension into the cheek from January 2011 to December 2015 were analyzed retrospectively.</p><p class="abstract"><strong>Results:</strong> Out of fifteen patients 8 were men and 7 women, two patients had SCC, rest had BCC. Average size of defect was 4.5 cm. Modified Imre’s cheek advancement flaps was used in all to reconstruct cheek defects while paramedian forehead flap was used for nasal reconstruction in 13 patients, skin graft and nasal advancement flap in one each. Eight patients underwent single stage reconstruction while seven with full thickness nasal defects had a delayed reconstruction. 13 patients rated their final appearance as satisfactory, while surgeon rated 12 patients with well-blended nose-cheek junction as satisfactory and lateral migration of junction being unsatisfactory. Alar retraction was observed in two patients with full thickness nasal defects. Two patients who underwent inner nasal lining reconstruction developed wound dehiscence while simultaneous reconstruction of nose and cheek was performed.</p><p class="abstract"><strong>Conclusions:</strong> Subunit principle application for composite nose and cheek results in symmetrical nose-cheek junction and appears excellent technique in achieving a satisfactory aesthetic outcome. Optimal results in full thickness nasal defects are achieved where reconstructing is delayed.</p>

The LN Flap for Nasal Defect Reconstruction: An 84-case Experience with a Novel Technique.

Background:The nose is a common site for cutaneous malignancy and post-ablative reconstruction. To our knowledge, a myocutaneous island flap based on the levator labii superioris alaeque nasi (LLSAN) and nasalis muscles, with vascularity from the lateral nasal and angular arteries, has not been described for reconstruction of the lower lateral nose.Methods:A retrospective chart review of patients who underwent LLSAN-nasalis island flap reconstruction between 2015 and 2019 was performed. The surgical technique involved marking of an inverted-V flap on the nasal sidewall. The skin lateral to the flap was then developed in the subcutaneous plane to expose the LLSAN muscle and divide its origin on the maxillary frontal process and its caudal insertions into the alar dermis. The medial incision was down to periosteum and perichondrium, and dissection beneath the flap separated it from the nasal support structure. The resultant flap had a great caudal mobility. The donor site was closed in a V-to-Y pattern.Results: In total,84 procedures were completed, mostly for alar defects (57.1%) between 100 and 400 mm2 (71.4%). The average age of patients was 74.9 years. An estimated 27 patients were lost to follow-up. At mean follow-up of 24.3 weeks, there were no cases of flap necrosis, 1 case of hematoma (1.8%), 1 case of infection (1.8%), 3 cases of persistent trapdoor deformity (5.3%), and 3 cases of alar notching (5.3%), 1 of whom required revision surgery.Conclusion:The LLSAN-nasalis myocutaneous island flap is a simple, reliable technique for resurfacing lateral lower nasal defects up to 2 × 2 cm.

Nose Reconstruction Using Local and Regional Flaps: The Challenges and Advantages.

Background:Nose is a central structure in midface. It has an important function in maintaining the aesthesis of the face. The three-dimensional (3D) structure of the nose is challenging to reconstruct. However, the availability of abundant vascularity and surrounding tissue is advantageous for the reconstruction of the soft tissue. Hence, this study was carried out to assess the cosmetic outcome and acceptability of patients undergoing nasal soft tissue reconstruction using local and regional flaps.Materials and Methods:Patients undergoing nasal soft tissue reconstruction using local or regional flaps, between January 2017 and December 2018, were studied. Patients requiring free flaps or skin grafts for reconstruction were excluded from the study. All the patients during follow-up at 3–6 months were asked to rate cosmetic acceptability and donor site cosmesis as bad, good, and very good.Results:In this study, 15 cases of nasal soft tissue reconstruction were studied. Among the 15 cases, 9 (60%) were male and 6 (40%) were female; the age range of patients was 7–65 years. Majority of the patients (5, 33.3%) had trauma as major cause of deformity. Post malignancy excision defect was the next major cause. All patients were happy with the results, only patient with composite graft complained regarding hyperpigmentation.Conclusion:Nose is an important structure in the midface. Apart from olfaction and respiration, maintaining adequate cosmesis is also an important function of the nose. Any deformity of the nose can be devastating to the patient. But, the 3D structure with varied structures makes reconstruction challenging to recreate. However, the availability of adequate donor tissue in local and surrounding region makes it advantageous. If principles of reconstruction are followed strictly, the outcome is good. Tissue expansion can be used whenever soft tissue requirement is more.

Cheek advancement flap for nasal reconstruction following surgical excision of basal cell carcinoma: early outcome and patient satisfaction

Background Many reconstructive techniques have been used for reconstruction of the nose after wide excision of basal cell carcinoma (BCC) with variable esthetic outcome. Patient satisfaction is a crucial determinant of the reliability of any reconstructive technique. Aim The aim of this prospective clinical study was to evaluate the cutaneous cheek advancement flap as a reliable method for nasal reconstruction following wide excision of BCC regarding early postoperative complications and patient satisfaction. Patients and methods The current study included 51 patients with BCC at side of nose who are eligible for wide excision and immediate reconstruction using cutaneous cheek advancement flap. Follow-up was planned for 3 months to report early postoperative complications. Esthetic outcome was assessed using Likert score and Vancouver’s scar scale. Results The age of the included patients ranged from 46 to 63 years. The current study showed wound infection in 3.9% of patients, seroma occurred in three patients, whereas hematomas occurred in two patients. No total flap loss was reported, whereas partial flap loss occurred in one (1.9%) case. The patients’ overall satisfaction was good, and only two (3.9%) patients showed poor esthetic outcome. There was a strong positive correlation between patients’ evaluation and independent surgeons’ assessment (r=0.922). Conclusion According to the current results, cheek advancement flap is a feasible and simple method for reconstruction of medium-sized and large-sized defects in the side wall of the nose with minimal postoperative complications and excellent esthetic outcome.

Tratamento cirúrgico de fratura nasal vinte anos após o trauma

Nasal bone fractures are very common, and their approach should be immediate to better repair the defects. This is not always possible, which makes the surgical procedure more complex, often going from a simpler fracture reduction to a nose reconstruction. There are several materials and techniques to perform this type of procedure, among them the implant made from polymethyl methacrylate (PMMA). This study aimed to report a case of nasal dorsum reconstruction using a customized in situ molded PMMA prosthesis. A 24-year-old male patient searched for a public hospital with sequelae of fracture in his nasal bones, resulting from a mule kick twenty years ago, with aesthetic complaints. On physical examination, a significant loss of projection of the nasal dorsum was observed with local cicatricial fibrosis. To correct the defect, a prothesis constructed from PMMA was molded and installed, fixed with plates and screws. The patient has been under follow-up for one year with an acceptable result. Although it is not the first option in many cases for nasal dorsum reconstruction, PMMA can be used to repair existing sequelae areas, achieving satisfactory aesthetic results.

Influence of skeletal class and facial type on nose dimensions in a Brazilian subpopulation: a CBCT study

Evaluating factors that may influence the nose dimensions and, therefore, contribute to the singularity of a person, is important for obtaining a precise facial reconstruction (FR) in forensic anthropology. Thus, the aim in this study was to evaluate the influence of sex, skeletal class, and facial type on nose dimensions of Brazilian individuals using cone-beam computed tomography (CBCT) scans. CBCT images of 54 males and 67 females were classified according to skeletal class (class I, II, or III) and facial type (brachycephalic, dolichocephalic and mesocephalic). Linear and angular measurements of the nose were performed using the CS 3D Imaging software. The measurements obtained for males and females were compared by one-way ANOVA. Two-way ANOVA was used to compare the measurements in the different skeletal classes and facial types. Significance level was set at 5%. All linear measurements were greater in males (p < 0.05); the angular measurements, however, did not differ between sexes (p > 0.05). Linear and angular measurements of class III males were significantly different from the other classes; the same was observed for the angular measurements in females (p < 0.05). Regarding facial types, some linear measurements were significantly greater in dolichocephalics males (p < 0.05). For females, there was no influence of facial type (p > 0.05), except for the nasal convexity angle. Nose dimensions differed in specific points among different skeletal classes and facial types, and there was sexual dimorphism in all linear nose dimensions. This information may be applicable for nose reconstructions, allowing more reliable FR.

Total nasal reconstruction with a forehead flap: Focusing on the facial aesthetic subunit principle

The nasal aesthetic subunit principle has been widely accepted as the standard for nasal reconstruction with forehead flaps. However, in our experience, one's impression of a reconstructed face can easily be represented by the nose's entire appearance rather than a single nasal component. Accordingly, we hypothesized that total nasal reconstruction focusing more on the facial aesthetic subunit principle would be superior to focal nasal subunit partial reconstruction. Here, we investigated the indication range of total nasal reconstruction and analyzed its effectiveness. Between July 2006 and December 2017, 32 patients who underwent total or subtotal nasal reconstruction were recruited. The total nasal reconstruction group (n = 20) was treated according to our modified facial aesthetic unit concept, while the subtotal reconstruction group (n = 16) was treated according to the nasal aesthetic subunit principle. Using retrospective reviews, we compared surgical details and aesthetic, and functional outcomes with visual analog scale scores. In aesthetic evaluation, nose contour (p = 0.009), nasal symmetry (p = 0.001), and nostril shape (p = 0.041) were superior in the total nasal reconstruction group. Satisfaction regarding the nose (p = 0.036) was significantly higher than that regarding the forehead and labial folds in the total group. Regarding function, there were no significant intergroup differences in nasal airflow, snoring, or olfaction. We suggest that total nasal reconstruction is not a strategy to avoid because of its aggressive nature. For selected suitable patients, the use of the total nose reconstruction focusing on our one nose concept can be a successful surgical option, and the reconstructed nose can be visualized as a real part of the face.

Alar facial sulcus and nasal ala reconstruction: a challenging anatomical area.

Background Most nasal cutaneous malignancies occur on the caudal third of the nose. Commonly, following resective surgery, the surgeon is requested to reconstruct the ala. Small skin defects of the nose may be left healing by secondary intention, although this may sometimes create an unpleasant scar. In the present paper we describe a 1-step reconstruction of the distal area of nasal ala, alar facial sulcus and cheek, with a segmented melolabial interpolated flap. Methods A 59-year-old man was operated for basal cell carcinoma involving the distal area of nasal ala and alar-cheek sulcus. The reconstruction was performed in 1-stage with a segmented melolabial interpolated flap used to reconstruct the anatomical missing subunits. Results Tumor-free margin was larger than the infiltrating region. No postoperative complications were observed. Conclusions The melolabial flap is a suitable option for the reconstruction of the nose, although the reconstruction of nasal ala is usually performed in 2-steps: the first one is performed to transfer the tissue and close the defect; the second, is performed to reshape the convexity of the ala and the concavity of the alar facial sulcus. In the present case, we do not perform a 2-steps reconstruction, we just reshaped the flap to perfectly fit the defect in 1-stage. The flap, supplied by collateral arteries from the facial and angular arteries, could be segmented for a better surgical outcome also during the harvesting stage if multiple anatomical subunits have to be reconstructed, with no need of a second surgical step that could be frustrating for the patient.