O-0705 TOTAL NASAL RECONSTRUCTION WITH OR WITHOUT SKELETAL SUPPORT: OUR PROTOCOL

The reconstruction of nasal skin is relatively easy when the defect involves one to two subunits. These cases are effectively managed with local flaps. However, when an extensive defect involves more than two subunits or the entire nose, a global nasal reconstruction must be consid- ered. From January 2009 to December 2011 we have treated 10 patients who needed a total nasal reconstruction. In 5 patients the reconstruction involved the external skin only after extensive tumour removal. The remaining 5 patients needed a total nasal reconstruction including internal and external lining and the osteocartilaginous support. In detail we reconstructed 2 cases of congenital arhinia, 2 cases of nasal destruction secondary to cocaine abuse and one case of total nasal loss owing to a squamous cell carcinoma. In all cases the nasal external skin was reconstructed with a paramedian forehead flap. In those patients where the hard tissue support was intact we only used cartilaginous grafts to support the alae. In the cases of arhinia we performed a two-step surgery. In the first session we created a new nasal fossa by a LeFort Osteotomy and a skin graft; at the same time we posi- tioned a forehead expander. In the second intervention we: removed the skin expander; created an internal lining with local flaps; created a skeletal framework with osteocarti- laginous grafts; rotated a forehead flap to create the exter- nal lining. In the two cocaine addicted we used the nasal remnants, deepithelialized, to create the internal lining, a costo- chondral graft to build the hard tissue framework and a paramedian forehead flap to create the external skin. The patient who had his nose lost for oncological reasons was reconstructed with a prelaminated forehead parame- dian flap. In a second surgical session the flap was mod- elled and a costochondral graft positioned to build the skeletal support. We have observed very good results in all cases with minimal donor site morbidity. While the technique is by itself not new, we believe that our protocol, that we here present, is ideal if we look at the results and applicable to different conditions that lead to major nasal defects.