Etiology

The challenge of nasal reconstruction is related to the complexity of the defect in an organ in which function, structural integrity, and contour are to be maintained. The differences in color, texture, and thickness between the nasal remnants and resources of skin available for the reconstruction pose aesthetic limits that are often difficult to overcome. The age, general health, and aesthetic goals of the patient should also be included in the decision-making process. These multifactorial problems can be approached with several reconstructive options, ranging from primary closure, healing by secondary intention, and skin grafting to the use of local or regional skin flaps. The decision as to which flap to use is based on a careful consideration of which tissue may be borrowed, how it can be repositioned, what the immediate- and long-term effects of moving that tissue will be, and how the scars may be hidden.

Flaps are the only reliable way to transfer bulk tissue for nasal reconstruction because their own source of nutrient blood makes them relatively independent of the vascularity of the recipient site for their survival. Flaps may therefore be used to cover nonvascular structures such as bare bone and cartilage. Nasal cutaneous flaps used to repair the nose provide excellent camouflage because of skin match in terms of texture, color, and thickness. Excess skin in the cephalic two-thirds of the nose can be moved into adjacent defects. The alar region is less suited for local transposition flaps or rotation flaps because the alar crease is often distorted or obliterated by the flap.

This article discusses the major principles of nasal reconstruction and describes the local and regional transposition flaps for the reconstruction of nasal defects.