Reconstruction of nasal ala and tip following skin cancer resection

Abstract

Background: Defects of the nasal ala and tip have a complex three-dimensional structure that makes them challenging to reconstruct. Many reconstructive options have been described for nasal ala and tip defects, ranging from primary closure to local flaps and skin grafts. However, it is difficult to determine which method will yield the best cosmetic results in each individual case. Thus, the purpose of this study was to determine which surgical procedures for reconstructing defects of the nasal ala and tip have better cosmetic results. Methods: From 2008 to 2018, 111 patients underwent surgery to reconstruct skin defects after resection of skin cancer in the nasal ala or tip. Their charts were reviewed to obtain data on age, sex, surgical location, size of the defect, surgical method, and cosmetic results using a visual analog scale (VAS). Results: For nasal ala reconstruction, the most commonly used surgical technique was the nasolabial flap (n = 42). This method also had the highest VAS score (7/10). The most commonly selected surgical method for nasal tip reconstruction was the bilobed flap (n = 13), and bilobed flaps and primary closure had the highest VAS score (7/10). Conclusion: Nasolabial flaps showed excellent cosmetic results for the reconstruction of nasal ala defects, while primary closure and bilobed flaps yielded excellent cosmetic results for the reconstruction of nasal tip defects.

Usefulness of full-thickness skin grafting from the infraclavicular area for facial reconstruction

“…In general, using a local flap is the first method of choice for constructing a facial soft tissue defect following skin cancer resection because it achieves cosmetically excellent results. However, when the defect size is large or if structural deformation is expected, FTSG is considered [ 7 ]. When selecting a skin graft donor site, not only skin characteristics, such as skin thickness, color, adnexal quality, and texture, but also a variety of other factors, such as surgical feasibility, scarring of the donor site, and patient satisfaction, should be considered.…”

V-Y Flap for Nasal Reconstruction

“…Surgeons with lesser qualifications, or surgeons unfamiliar with surgery of the external nose, should not venture here. 5 , 6 , 8 , 10 , 12 Examples found outside the plastic surgical literature were decidedly poor. 11 , 12 , 13 , 15 , 16 …”

“… 7 , 10 Fifth, the nasal alae should not be elevated. 8 , 11 , 12 Sixth, the columella should not be used as a donor site, as this obviously narrows the columella, creating an unnecessary deformity. 4 , 7 Seventh, pinching the tip is a form of distortion.…”

A practical approach to nasal reconstruction in Asian patients

“…Various surgical procedures can be used for nasal reconstruction, such as skin grafting, local flaps, and distal flaps, depending on the defect’s location, extent, and condition [ 1 ]. However, the currently available nasal reconstruction guidelines are primarily based on Caucasian physical features, and reconstructive surgery in Asian patients tends to yield less satisfactory results due to racial differences in anatomy and healing physiology [ 2 ].…”