Nasal reconstruction
The nose has a central position in the face and serves as the key anatomic area for aesthetic and facial balance. Due to its central position the nose is very often involved in facial burns. Due to its importance nose reconstruction plays a major role in
- PDF / 496,657 Bytes
- 4 Pages / 595 x 785 pts Page_size
- 22 Downloads / 197 Views
Medical University of Vienna, Department of Surgery, Division of Plastic and Reconstructive Surgery, Vienna, Austria State Hospital Wiener Neustadt, Department of Surgery, Section of Plastic, Aesthetic and Reconstructive Surgery, Wiener Neustadt, Austria
The nose has a central position in the face and serves as the key anatomic area for aesthetic and facial balance. Due to its central position the nose is very often involved in facial burns. Due to its importance nose reconstruction plays a major role in regaining quality of life, but beside its aesthetic impact the nose also plays a major role as a functional organ in the upper airway. Advances in the philosophy, approach, and techniques for nasal reconstruction have resulted in increasingly refined aesthetic and functional results. This has been achieved by adhering to the paradigm of replacing missing tissue with like tissue. The tenets include replacing the: ▶ Lining, ▶ Framework, and ▶ Cover of the nose with material that matches the deficient tissues as close as possible. Achauer has described a nasal deformity according to the following schema [1]: ▶ Burn scar deformity without major tissue loss (hypertrophic scars, hypo- and hyperpigmentation, asymmetry), ▶ Ectropium (e. g. due to the loss of the alar rim), ▶ Subtotal tissue loss, ▶ Extensive tissue loss, ▶ Nostril stenosis. Fig. 1. Aesthetic subunits of the nose
241 L. -P. Kamolz el al. (eds.), Handbook of Burns © Springer-Verlag/Wien 2012
L.-P. Kamolz et al.
Fig. 2. Late results after defect coverage (frontal view): Dorsum: full thickness graft Tip – Alar Region: tunneled nasolabial island flap
Principles of nasal reconstruction Nasal reconstruction in patients suffering from burns is similar to nasal reconstruction in patients suffering from cancer. The most important factors are soft tissue coverage, lining and skeletal support. Therefore an exact analysis of the missing tissue has to be performed prior to surgery in order to understand the tissue needs. If there is only a need for skin coverage an unmeshed split thickness or full thickness skin graft is required. Don’t forget to take the aesthetic subunits of the nose into account (Fig. 1) [2, 3]. In case of
Fig. 3. Late results after defect coverage (lateral view): Dorsum: full thickness graft Tip – Alar Region: tunneled nasolabial island flap
242
Fig. 4. Preexpanded forehead flap
small defects and good quality of the surrounding tissue a local flap can be used to solve the problem (Figs. 2, 3). In case of extensive or subtotal tissue loss, autologous material and alloplastic material can be used for bony augmentation or bony reconstruction. Concerning to the literature, autologous material seems to be superior than alloplastic material due to their possible complications, which are associated with use of alloplastic materials [4 –10], but in both cases an adequate soft tissue coverage is of utmost importance. Bone and cartilage are really optimal for replacing the framework of the nose. Generally free grafts harvested from the rib, calvarium,
Data Loading...
