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Modified Nasal Reconstruction Technique Has Largely Excellent Outcomes

Modifying the nasal subunit principle to achieve coverage of nasal skin defects in nasal reconstruction after skin cancer ablation has largely excellent results.

An analysis by specialists at the Hospital of the University of Pennsylvania, Philadelphia, United States, showed outcomes classed as excellent in 85% of 74 patients who had undergone reconstructive procedures which violated the classic nasal subunit principle. Outcomes were good in 13% and fair in 2%.

Eight of the 74 patients had complications and eight had 10 revisions.

The specialists noted that the nasal subunit principle had popularised the technique of reconstructing specific topographic subunits - the dorsum, tip and columella, and the paired alae, sidewalls and soft triangles.

In patients with more than 50% of subunit loss, it had been proposed to remove what was left of the subunit and reconstruct it entirely with a skin graft or flap.

The placement of incisions for local flaps along borders of aesthetic subunits to maximise scar camouflage was also recommended.

The specialists said that although the concept of nasal subunits was important in planning the reconstruction, other aesthetic considerations were also crucial for optimal results. These included skin texture, colour, contour and actinic damage.

Although focusing on those aspects, with the goal of nasal symmetry in mind, led to the violation of the subunit principle, it provided pleasing results both with the defect and at the donor site.
Plastic and Reconstructive Surgery 2003;111:2:639-648. "Aesthetic considerations in nasal reconstruction and the role of modified nasal subunits."

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