Request pdf on oct 1, 2009, mark b constantian and others. Sequelae because of lesions caused by syphilis and leprosy stimulated advances in nasal reconstructions during the renaissance, and. Jan 01, 2012 the nose is the central feature that defines ones face. However, the conspicuous scarring and loss of conformity in the cosmetic subunits of the nose might be. They are reserved for small defects of the temporoparietal scalp. Aesthetic refinements in forehead flap reconstruction of.
Resection of benign lesions is a common cause of nasal defects in young patients. Nasal reconstruction reconstruction is about choices. Skin tension and its distribution are important to avoid distortion of key facial landmarks such as the eyelid, lip, and the nasal ala. The conventional bilobed flap zitellis design used for reconstruction of defects of the lower third of the nose traditionally utilizes skin from the mid dorsum and the sidewall of the nose. There are, as yet, no controlled studies on the quality of nasal reconstruction. We assessed whether engineered autologous cartilage grafts allow safe and functional alar lobule restoration.
Now, extensive nasal defects are more likely due to ablation from tumor than from trauma. The work of millard, and burget and menick has elevated nasal reconstruction to. In 1975, herbert found that the nasogenian skin region is ideal in color and texture for nasal reconstruction 5. Introduction the first reports of nasal reconstruction date back to 2000 b. However, for larger nasal defects, the donor site at the cephalic portion of the forehead is frequently too large to be closed primarily. Nasal reconstruction may have been performed as long ago as 3000 bc in india.
Understand current developments in the use of intranasal. Forehead flap method for total nasal reconstruction. In this operation a reconstructive surgeon uses skin from the forehead above the eyebrow and pivots it vertically to replace missing nasal tissue. They introduced 3 important concepts that are universally accepted as helpful in achieving optimal aesthetic and functional results when reconstructing large defects of the nose or complex defects of the central face, which involve the nose and adjacent facial regions including the. In india, sushruta described the use of the median forehead flap for total reconstruction of the nose, known to date as the indian method 2. Nasal reconstruction with composite chondrocutaneous grafts dr sumer yadav plastic surgery 2. Reconstruction of a fullthickness nasal defect requires repair of three distinct layers. Nasal reconstruction surgery london the face surgeons. Prostheses commonly result in a good aesthetic outcome and remarkable acceptance in many cases. Described by his peers as the finest nosemaker in the history of medicine, dr. The nose is the central feature that defines ones face. Differences in ethnic asian anatomy and wound healing may foster suboptimal outcomes.
A nasal reconstruction authority shows you how to obtain the best outcomes and repair unsatisfactory results from former surgeries. Highlighted are its indications, technique, complications, and clinical success, particularly in comparison with the other common modalities for reconstructing this nasal lining. Defects in the tip and nasal septum can cause significant airway obstruction, as can sudden changes in the nasal contour. Aesthetic nasal reconstruction principles and practice. Aesthetic nasal reconstruction principles and practice ncbi. Louis, a book which revolutionized softtissue reconstruction of the nose. In addition to presenting the latest principles and techniques, this new resource also examines evolving concepts and methods, keeping you at the forefront of todays practice. So nasal reconstruction is both a challenge and an opportunity for the specialty of plastic surgery. Numerous techniques are described in the literature, but a primary reconstruction with a final good. However, all forehead flaps, regardless of their vascular pedicles, are thicker than normal nasal.
In addition to presenting the latest principles and techniques, this new. Nasal reconstruction using a paramedian forehead flap. Principlization of plastic surgery download ebook pdf. The work of millard, and burget and menick has elevated nasal reconstruction to an art form. He underwent partial rhinectomy and medial maxillectomy followed by staged reconstruction. Because of its ideal color and texture, forehead skin is acknowledged as the best donor site with which to resurface the nose. The nose book available for download and read online in other formats. Esthetic refinements in forehead flap nasal reconstruction. A 10year experience in nasal reconstruction with the threestage forehead flap frederick j. A 10year experience in nasal reconstruction with the.
Preliminary stages before nasal reconstruction using forehead. If the defect is small and superficial it can be resurfaced with a skin graf or it can heal by secondary intention. Preliminary study of the total restoration of the facial skin. These smaller parts tip, dorsum, sidewalls, alar lobules, and soft triangles may be. Mass losses were mapped according to the anatomic subunits described by burget and menick. Usefulness of the subunit principle in nasal reconstruction. The unique character of this subunit and the complex relationships with a number of different facial or nasal subunits make the excision of large tumors difficult to manage.
In 1837, warren performed the first forehead flap nasal reconstruction. Menick offers a comprehensive overview of nasal reconstruction and rhinoplasty on emedicine, a webbased clinical reference guide, as well as the articles listed below. We present three cases of nasal reconstruction using a forehead. Menick, aesthetic nasal reconstruction, 1994, mosby year book st. Before nasal reconstruction can be accomplished, the nose must rest on a stable platform to avoid late nasal obstructions, and septal deviations resulting from scar contraction.
Nasal reconstruction is challenging due to the central position and role of the nose in the face. Advancement perforator cheek flap for aesthetic onestage. Use of skin flaps for nasal reconstruction after neoplastic. Any wound will heal by secondary intention or can be closed with a skin graft or a local or regional flap. Modification of the subunit principle for reconstruction of nasal tip and dorsum defects. Art and practice article in plastic and reconstructive surgery 1244. Nasal reconstruction using a paramedian forehead flap wikipedia. Thus, nasal reconstructions should respect the aesthetic nasal subunits, including the dorsum, tip, columella, wings, sides. Gangplank flap reconstruction of the nose archives of. Oct 24, 2008 burget and menick have written a seminal text on functionally and esthetically superior nasal reconstruction. We report a case of a 61yearold patient who presented to us for nose and cheek reconstruction post multiple excisions of an extensive recurrent basal cell carcinoma bcc of the right cheek and most of the nose.
Limited alar defects can be resurfaced using a nasolabial flap, however, the amount of. Nasal reconstruction is one of the most challenging and rewarding procedures performed by the plastic surgeon. Pdf nasal reconstruction continues to be a formidable challenge for most plastic surgeons. Understand the history of nasal reconstruction and its implications to modern nasal repair. The use of otherwise redundant skin to provide nasal lining in the reconstruction of fullthickness alar defects by nasolabial flap repair. A wide variety of surgical techniques are then described with the aid of highquality illustrations, covering nasal airway procedures and surgical approaches to the paranasal sinuses, including diverse endoscopic and imageguided procedures, nasal reconstruction, and endonasal and external rhinoplasty. The paramedian forehead flap is commonly used for nasal reconstruction. Pdf our algorithm for nasal reconstruction researchgate. Historically, the indian method of nasal reconstruction with forehead flaps and tagliacozzis arm flap methods are two of the earliest described procedures in the specialty that was to become plastic surgery. Nasal reconstruction with a prefabricated free flap. The surgeon should be able to provide functional and aesthetically refined nasal reconstruction by mastering the local anatomy 7.
Use of lateral forehead rotational flaps to close paramedian. However, if the goal is the restoration of normal, principles of regional unit repair are applied. The nasal surface is made up of several concave and convex surfaces separated from one another by ridges and valleys. My nose is healing rapidly and i feel normal again a delicious feeling.
A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. A philosophy for treating complex nasal defects archives. After studying this article, the participant should be able to. Gonzalezulloa has designated the nose an aesthetic unit of the face. Composite graft described by konig 1887 phase i cut graft dead white phase ii 6 hours postop pale pink phase iii 12 24 hours postop deep cyanosis phase iv 3 6 days graft acquires healthy color the wider the surface contact, the more rapid the revascularization. Oct 28, 2010 king ravana arranged for the reconstruction of lady surpunakhas nose by his physicians, documenting one of the earliest accounts of nasal reconstruction. Autologous native cartilage from the nasal septum, ear, or rib is the standard material for surgical reconstruction of the nasal alar lobule after twolayer excision of nonmelanoma skin cancer. The book is a collaborative project between the new generation of turkish specialists and well. Fred menick has developed a pioneering approach to aesthetic nasal reconstruction, informed by 35 years of clinical practice and reinforced by timetested principles. The latest twovolume textbook from the worlds leading authority on nasal reconstruction, frederick j. The mainstay of management of primary cutaneous melanoma is wide surgical excision, but occassionally a balance is needed between adequately resecting a potentially curable lesion and minimising the functional deficit or cosmetic deformity in the affected area, particularly in the head and neck region. This article appeared in a journal published by elsevier. The attached copy is furnished to the author for internal noncommercial research and education use.
Osteocutaneous radial forearm free flap in subtotal nasal. Changes in technique have resulted in the evolution of the modern. Forehead flap method for total nasal reconstruction core. May 07, 2014 before the techniques for nasal reconstruction being discussed, some general comments regarding the nature of nasal skin are warranted. We assessed whether engineered autologous cartilage grafts. The epithelial turnin flap in nasal reconstruction jama. It is undesirable in nasal reconstruction, because minor flaws in preoperative plan can produce large distortions. This document was downloaded for personal use only. This study analyzed 103 nasal skin flaps used in the reconstruction of 102 nasal mass losses that resulted from tumor resection in 96 patients who underwent surgery between december 2008 and december 2011. A 66yearold man presented with a large squamous cell carcinoma of the right nasal vestibule. The superiorly based bilobed flap for nasal reconstruction.
The epithelial turnin flap in nasal reconstruction. King ravana arranged for the reconstruction of lady surpunakhas nose by his physicians, documenting one of the earliest accounts of nasal reconstruction. Skin grafts can be taken from areas of the body such as thighs, forehead and buttocks, whereas cartilage is often taken from elsewhere in the nose, the ear or the ribs. Refinements and outcomes of forehead flap nasal reconstruction largely reflect western experience. Gary burget, md, and frederick menick, md, 1 are pioneers of modern techniques used for nasal reconstruction. Pdf nasal reconstruction is always challenging for plastic surgeons. The challenge of nasal reconstruction the nose dominates the central face, and when it is. The nose rests on a platform comprised of the premaxilla and the piriform aperture surrounded by the upper lip and cheek. Aesthetic reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. Reconstruction of the nose requires attention to form and function considering the size and localization of the defect with regard to the existing aesthetic subunits. Some aspects of nasal reconstruction are established in the literature as proposed by burget and menick 6. Sir harold gillies 18821960 was one of the first to outline the basic principles used in current nasal reconstruction, whereby three basic constituents are required for nasal restoration. Menick nature will heal almost any wound by secondary intention eventually. A forehead flap is usually required if the nasal defect is larger than 1.
The modified folded forehead flap for nasal liningthe menick method in reconstructive surgery and oncology for surgical. Paramedian forehead flap reconstruction for nasal defects the paramedian forehead flap is the ultimate reconstructive method for repair of extensive nasal defects. Pdf nasal reconstruction continues to be a formidable challenge for most. This platform needs to be stable before planning a nasal reconstruction. This case report details the patients unique journey. There are two methods for covering extended nasal resection defects.
An approach to the late revision of a failed nasal reconstruction. Any skin graft or flap or physician can close a defect. A modified bilobed flap design for nasal tip defects. Nasal reconstruction was achieved with a free helical rim flap for the right ala and a staged prefabricated radial artery forearm free fascial flap. To evaluate the epithelial turnin flap for reconstruction of the internal lining in fullthickness nasal defects. Burget and menick brought nasal reconstruction to its present standards. A militarycivilian team collaborated throughout her reconstructive planning, treatment, and postoperative course to create both an aesthetically acceptable and functional subtotal nasal reconstruction. Facial skin cancer reconstruction facial skin cancer reconstruction meaike et al. We present three cases of nasal reconstruction using a forehead flap in which we performed a preliminary stage to increase reliability of outcomes. We modified methods to address asian features by extending subunit and flap boundaries, minimizing flap thinning, and overbuilding the nasal framework to combat.
The surgery has changed the outlook i have about myself and my selfconfidence. Adaptable nasal reconstruction with an axial forehead flap. Converse jmcomposite graft from the septum in nasal reconstruction. Other authors have described particular reconstructive techniques that can be used advantageously to repair defects at certain special sites. Download and read free online nasal reconstruction. A face without its nose is as lost as a sundial without its gnomon. Nasal reconstruction using a paramedian forehead flap is a surgical technique to reconstruct different kinds of nasal defects. The first written record of the indian forehead flap was in 1440. The nasal skin is typically divided into three zones. Learn more about nasal reconstruction, paramedian forehead flap or about rhinoplasty tip surgery. Burget gc, menick fjthe resurrection of skin grafts for lining.
654 572 950 1176 1483 669 1534 1524 334 1406 266 300 717 845 1139 149 1306 406 332 1511 487 1100 68 300 1366 506 1489 619 676 1429 854 186 1 476 395 1205 1080 601 173 1270 561 178