Reconstruction of the nose encompasses innumerable situations and uses very varied reparative techniques depending on the etiology (tumour, traumatic, malformative), age, sex, associated pathologies, location, as well as the extension and the depth of substance loss. Appearance is an important social function and is crucial when it affects the face and nose. Thin cartilage covered by a mucoepithelial plane with its cutaneomuscular covering is enough for the normal nose to perform all its functions.
Is It Possible To Reproduce This Model Of Morphofunctional Subtlety?
It has not yet been achieved: the reconstructions are imperfect, and the election strategy has not yet been established. The best techniques take advantage of scar retraction with the principle of aesthetic units, and at the same time, they oppose it using an oversized skeleton. There is still room for improvement: prevention is possible by drawing on the lesson of advances in lip-palate rhinoplasty, as evidenced by the first convincing results of immediate closure of dead spaces, followed by properly performed nasal shaping, which is effective in nasal reconstruction.
For superficial losses of substance from the upper part of the nose, "island" advancement flaps are most useful. Total skin grafts are an excellent indication of such losses, as well as the tip of the nose. At this level, the new variants of the Rybka myocutaneous "island" flap, that mobilizes the entire dorsolateral skin of the nose by advancing and rotating over the superior alar artery, they are adequate for most situations. For penetrating loss of substance from the tip, atrial compound grafts and nasolabial or frontal flaps with transient pedicles are the best solutions.
Finally, the quality of wide reconstructions is related to the simultaneous treatment and improvement of the choice of nasal lining, skeleton and skin coverage by means of a frontal flap, provided that scar retraction is controlled from the first surgical stage by means of the closure of dead spaces and the use of a conformation during the first four postoperative months. For penetrating loss of substance from the tip, atrial compound grafts and nasolabial or frontal flaps with transient pedicles are the best solutions.