[Surgical reconstruction of the external nose: personal experience]

Because of the ensuring malformations, most often vascular in nature, malignant tumors of the nasal pyramid often require partial or total exeresis of the nasal structures. These tumors are most commonly basal cell carcinoma (85-90%) and squamous cell carcinoma (7-8%). A recent epidemiological survey performed in Italy showed that, in this country, such carcinomas account for approximately 13% of all malignant cutaneous neoplasms of the head and neck region. This work presents the author's personal experience in 8 cases of partial, subtotal and total reconstruction of the nose, performed over 5 years of clinical activity. The cases include 8 patients (4 males and 4 females, age range 48-95 years, mean age 77.3 years): 7 cases of malignant cutaneous nasal tumors (5 basal cell, 1 squamous cell and 1 basal-squamous cell carcinoma) and 1 case of iatrogeneous perforation through the entire thickness of the right nasal wall, approximately 7-8 mm in diameter, the outcome of sclerotizing treatments initiated 30 years before for angioma. On the whole, including the case of iatrogeneous nasal perforation the following procedures were used: 7 frontal fascio-cutaneous flaps and 1 nasal-genienic flap associated with a median of upper lip muscle. As regards the frontal flaps, in 5 cases a variation was used where the inset base was set more medially and with dimensions different from up-and-down Converse flaps. In 2 other cases a median frontal flap was used. Except for one case of partial necrosis of the flap, healed by subsequent surgery, complications were not particularly important from the clinical point of view and occurred in the broadest exeresis, where reconstruction of the structures adjacent to the nose and the mucosa lining proved necessary. On the whole, considering the initial stages of the lesions and the often advanced age of the patients, the surgical treatment gave good results from the oncological, aesthetic and functional points of view.