Nasal Reconstruction

Nasal reconstruction surgery is a procedure frequently performed after removing skin cancer on the nose. The reconstructive technique is determined by the size and depth of the defect on the nose. Small defects less than 5mm may be repaired by a primary closure. This means the edges of the wound are sutured together in multiple layers. The wound is then made into an ellipse to allow for a smooth closure after nasal reconstruction.

Defects on the nose that are between 5mm and 15mm may be repaired with local flaps or skin grafts. A local flap is tissue from the nose that is repositioned to fill the defect. Additional incisions are required to create the flap. The following pictures show reconstruction of a nasal wound with a local bilobed flap.

 

 

The advantage of a flap procedure for nose reconstruction is that flaps maintain a vascular supply and can be composed of multiple tissue layers, including muscle, fat, and skin. Defects on the nasal tip or alar generally benefit from the replacement of multiple tissue layers. This allows the surgeon to replace exactly the tissue that was removed. In addition, local flaps tend to have a very good color match with the surrounding nasal skin after reconstruction of the nose.

Skin grafts may also be used for defects between 5mm and 15mm, or even larger defects. Skin grafts seem to have their best results on the upper 2/3s of the nose where the skin is thin. Skin grafts only replace skin, and therefore tend to provide relatively thin coverage for nasal reconstruction. Skin grafts will frequently result in a color mismatch with the surrounding nasal skin after nose reconstruction. In addition skin grafts are not generally used in defects with exposed or missing cartilage. These complex defects usually require a flap.

Larger defects may require a pedicled flap such as the forehead flap. Nasal tip or alar defects larger than 15mm usually benefit from forehead flap nose reconstruction. The forehead flap requires two or three stages to complete. In the following case, the nasal tip defect extended down to the nasal tip cartilage and a forehead flap was used to reconstruct the nose. The procedure took two stages.

 

 

In this second example, the defect was significantly more complex. In this case, not only was the skin removed, but also the underlying cartilage and internal nasal lining. For this situation, all layers should be reconstructed during surgery on the nose. First, the internal nasal lining was reconstructed with a nasal septal flap, then the cartilage was reconstructed with ear cartilage. Finally, the skin and subcutaneous fat was reconstructed with a forehead flap. This type of nose reconstruction was performed in two stages.