Usefulness of the subunit principle in nasal reconstruction

Abstract

The subunit principle in nasal reconstruction proposed the concept of reconstructing the specific topographic subunits that were identified as dorsum, tip, columella, the paired alae, sidewalls, and soft triangles. In patients with more than 50% of subunit loss, removing the remaining portion of the subunit and reconstructing the entire subunit may yield better results. The placement of incisions along the borders of the subunits minimizes scar lines. Furthermore, as trapdoor contraction occurs, the entire restored subunit bulges in a way that mimics the normal contour of a nasal tip, dorsum or ala. Two cases of nasal reconstruction that followed this important principle are described.

Mustardé flap for primary nasal sidewall defect post-Mohs micrographic surgery

“…The subunit principle proposes the idea that surgically replacing an entire subunit, instead of patching the primary defect, allows scars to be hidden in the contours of the nose and decreases the risk of trapdoor contractions. 6 If a trapdoor contraction does occur, subunit replacement forces the contraction to follow the shape of the nasal tip, dorsum, and ala, decreasing its appearance. 6 The slight manipulation of the Mustardé flap mimics the crease of the ala, successfully concealing incision lines.…”

Case Report: A Preferred Reconstructing Modality to Restore Neoplastic Nasal Alar Subunit Defects: Sequential Facial Artery Perforator Flaps

“…However, distortion and asymmetry often appear after reconstruction with a nasal local flap, especially in large-area defects, and are attributed to the lack of reservoir tissue in the nose. Therefore, other regions of the skin adjacent to the nose, such as the skin from the nasolabial groove and cheek, are frequently used to create flaps (6) and are particularly favorable for defects affecting more than 50% of the nasal aesthetic subunits (7). Among the flap procedures, the facial artery perforator flap method is good for repairing defects of the alar subunit (8)(9)(10).…”

Reconstruction of Postburn Nasal Alar Defect by Paramedian Forehead Flap

“…For nasal reconstruction, the aesthetic facial subunit principle, which is considered the gold standard for nasal reconstruction surgery [1] must be considered throughout. The subunit principle was described in 1985 by Burget and Menick. It's about reconstructing the entire subunit rather than cover the defect when a large portion of a subunit has been removed [2]. The nose consists of a total of eight subunits.…”