Nasal Reconstruction

Nasal defects are a difficult problem and nasal reconstruction should be accomplished while maintaining adequate nasal function.

The midline forehead flap or the "Indian" flap provides the principal and fundamental technique for nasal reconstruction even today.

Nasal reconstruction began sometime around 2000 B.C. in India because Indian culture then, believed in punishment of adultery by amputation of the nasal tip. Around 600 B.C. Sushruta Samhita documented the first facial flap for reconstruction of the nose, through the use of the midline forehead flap, or "Indian" flap.

The best donor site for nasal defects is the forehead. It is an excellent match for color and texture, reliable blood supply and minimal donor site deformity. The disadvantage is that it leaves a forehead scar and the length is limited.

One must consider what the patient desires. When the goal becomes reconstruction of an aesthetically appealing nose, it should be thought of as three-dimensional.

The nose is composed of a vascular lining, support structures and a covering. The structural support and the vascular lining are interdependent. The lining depends on the cartilage for support and the cartilage depends on the lining for its vascular supply. Nasal lining is best reconstructed from intranasal donor sites.

The blood supply for the intranasal lining flaps can arise from several sources with the main source being the septal branch of the superior labial artery. Replacement of nasal lining can impair nasal function if not done correctly. Usually this is seen when tissues such as skin grafts, local nasal skin and composite auricular grafts are used for lining.