Cause

Nasal reconstruction has been refined to the point that its goals should include full restoration of form and function in addition to an aesthetically pleasing result. Contemporary facial plastic surgeons have all the tools available in their armamentarium to repair the complex composite structure of nasal lining, structure, and skin cover. Nasal defects most often result from oncologic surgery (Mohs, wide local, or square excision) or nasal trauma. Of paramount importance in the reconstruction of oncologic defects is the confirmation of clear resection margins before undertaking reconstruction. Failure to confirm clear margins risks tumor recurrence, rendering moot the successful nasal reconstruction. Mohs micrographic surgery lends itself to immediate confirmation of clear margins. Wide local excision, on the other hand, relies on frozen-section analysis of a representative sample of the defect margin or delayed reconstruction, allowing time to confirm negative margins of permanent pathologic specimens.

Although this article focuses on reconstruction of oncologic defects, the principles discussed can be effectively applied to reconstruction of nasal-lining defects resulting from any cause. Restraint should be exercised in the initial management of traumatic, or otherwise contaminated, defects to allow elimination of potential wound contamination before repair. In many cases, expectant management results in sufficient healing by secondary intention to either reduce the significance of the required reconstruction or preclude surgical intervention.