tumors and trauma can destroy the nasal shape, plastic surgeons always try to reconstruct the nose. this presentation covers all simple and complicated nasal problems

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NASAL RECONSTRUCTION
An Aesthetic Overview
By
Hussein Saber Abulhassan
Professor of Plastic Surgery
Department of Surgery,
University of Alexandria

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I. History
A. “Indian method”
1. 600 BCE: Sushruta Samhita
(forehead and cheek flaps).
2. 1440 CE: Kanghiara family
(forehead flap).
3. 1816: Carpue reported the
“Indian method” in the English
literature.

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Indian forehead flap for nose reconstruction.
Description in text (from Joseph)

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I. History
B. “French method”: Cheek
flaps
C. “Italian method”
1. 15th century: The Brancas of
Sicily used cheek and arm
flaps.
2. 1597: Gaspare Tagliacozzi
used the arm flap.

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II. Nasal anatomy
A. The nose is divided into thirds, according to
the underlying support.
1. Proximal third: Nasal bones and bony septum.
2. Middle third: Upper lateral cartilages and septum.
3. Distal third: Cartilaginous septum and alar
cartilages.
a. Medial crura.
b. Alar domes.
c. Lower lateral cartilages.

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II. Nasal anatomy
B. The soft tissue envelope conforms to the
underlying structures.
1. The zone of thin skin (dorsum and columella) is
loose and mobile, with few sebaceous glands.
2. The zone of thick skin (nasal tip and ala) is fixed to
the underlying cartilage and is oily, with many
sebaceous glands.

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Surgical Anatomy
Aesthetic subunits of the nose
(Millard and Burget)

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Etiology of nasal defects:
1. Skin Cancer
– BCC
– SCC
– Melanoma
2. Trauma
3. Congenital

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Basic Principles of
Nasal Reconstruction

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Basic Principles of Nasal Reconstruction
Restoration of “normal”.
Replacement.
Template.
Skin.
Scar placement.
Final stage.
Burget 1985

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Principles of aesthetic units
A.Burget and Menick
characterized nine
topographic subunits of
the nose.
1. Dorsum
2. Tip.
3. Columella.
4. Sidewall (two).
5. Ala (two).
6. Soft triangle (two).
Aesthetic subunits of the nose

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B. The tip, ala, sill, and columella compose the
nasal lobule.
C. If possible, incisions should be designed along
the borders of adjacent subunits for
camouflage.
D. As a general rule, if the defect occupies more
than 50% of a subunit, enlarge the defect to
incorporate the entire subunit. Reconstruction
of an entire subunit is generally aesthetically
more pleasing.

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E. If available, use an undamaged
contralateral subunit as a model on
which to pattern the missing subunit.
F. Divide large defects into multiple
subunits and address each with a
separate graft or flap; avoid the
temptation to reconstruct multiple
subunits with one large flap.

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Historical Converse Scalping Flaps
Courtesy of our professor Dr FARID MOUSTAFA.

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Courtesy of our professor Dr FARID MOUSTAFA.

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Courtesy of our professor Dr FARID MOUSTAFA.

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Courtesy of our professor Dr FARID MOUSTAFA.

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• Local flaps for nasal skin cover
exploit the laxity of the upper two-
thirds of the nose to cover the
lower one-third, as in these
examples.
A. The Banner flap is a transpositional flap
suitable for small defects of the dorsum
or sidewall.
B. the bilobed flap is a double transposition
flap. The second flap is designed at 90 to
100 degree from the first.
C. The Riegen (sickle-shaped dorsonasal)
flap is based laterally on the angular
artery.
Local flaps for nasal skin cover

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Nasolabial Flaps

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Reconstruction of the
Columella

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Burget &
Menick
PRS August 1989

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Thank You