Mª Jesús Martínez González⁽¹⁾, Alejandro Nogueira⁽²⁾, Olatz Alcelay⁽³⁾, Teresa Pérez ⁽⁴⁾, Francisco Iglesias^{(5)
(1)(2)(3)(4)(5)}Hospital Central de Asturias - OVIEDO. Spain

	[Plastic Surgery]

INTRODUCTION

Surgical reconstruction of the nose evolved along three basic lines: the Indian method, using forehead flaps; the French method, with lateral cheek flaps; and the Italian method involving arm flaps ^(1,2). The choise of reconstructive method is based on the size, location, and depth of the defect requiring replacement.

MATERIAL & METHODS

A 36-year old man suffers a human bite that produces nasal amputation with avulsion of the nasal tip, alar portion, coluella and supratip.fig.1.

RESULTS

At emergency we tried the replantation of the amputed segment as a composite graft,fig. 2 that was unsuccessful,fig. 3 so delayed reconstruction was planned by "L" shaped septal graft and conchal graft for the tip.fig.4. Skin cover was performed by forehead flap, according to the defect fig.5,fig.6,fig.7; with a skin graft for the undersurface of the flap for the nasal lining. Tha flap is separated in a second stage, cutting off the pedicle and restoring the tissues. The patient was operated 6 more times for small corrections: skin fittings, w-plastias..The final result after two years period is excellent.fig. 8,fig.9.

DISCUSSION

Planning the reconstruction of the nose, accurate analysis of the defect is essential; if the three layers (skin, skeleton and lining) are lacked the reconstruction becomes more complex and less predictable; choosing the donor site is important the skin thickness, colour, texture and size of the defect and the remaining skin ⁽³⁾.

In our opinion is important to achieve nasal external cover, skeleton elements and lining in a single operation, because the skin is more pliable and flexible, and is easier to mantain the tip´s projection than try to recapture it after it is bound dowm by scar ⁽⁴⁾. We consider that the "L" shaped septal grafft and conchal graft for the tip covered with a forehead flap, with a skin graft on his surface for the lining perform an adequate plannig.

CONCLUSIONS

The goal of the nasal reconstruction is to provide both an aesthetic result and a patent and humidified airway, "L" shaped septal graft and conchal graft for the tip covered with a forehead flap is an ideal procedure to achieve this goal in one stage

BIBLIOGRAPHY

Barton FE. Nasal reconstruction. In: J.W. Smith, S.J.Aston, (eds) Grabb´s and Smith Plastic Surgery. Boston: Little, Brown and Company.P491,1991.
Barton FE. Nasal reconstruction. Selected readings in Plastic Surgery, 7:1, 1994.
Burget G, Menick FJ, Aesthetic reconstruction of the nose. St Louis: Mosby, 1994.
Manson PN, Hoopes JE, Chambers RQ et al. Algorithm for nasal reconstruction. Am. J. Surg. 138: 528, 1979.

Discussion Board

Any Comment to this presentation?

[ABSTRACT] [INTRODUCTION] [MATERIAL & METHODS] [RESULTS] [IMAGES] [IMAGES-2] [DISCUSSION] [CONCLUSIONS] [BIBLIOGRAPHY] [Discussion Board]

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	[Plastic Surgery]

Mª Jesús Martínez González, Alejandro Nogueira, Olatz Alcelay, Teresa Pérez , Francisco Iglesias
Copyright © 1999-2000. All rights reserved.

Last update: 14/01/00