[Refinement of partial and total reconstruction of the nose]

In this surgical field, sophisticated refinements of the complex structures of the tip, the alae and the columella are required to achieve a corrected rather than a reconstructed appearance of the nose. The conventional corrective rhinoplasty should complete the reconstructive work. Apart from skin grafts and composite grafts for small repairs, the author currently uses only the fronto-parieto-occipital flap (Galvao) for total reconstruction, and the fronto-temporal flap (Schmid-Meyer), as well as the complex frontal island flap with the supratrochlear artery as pedicle for partial repairs. The author has abandoned several other techniques. The principle of the two last techniques consists in the preformation of the apico-columello-alar structure with the appropriate skin and cartilage grafts already in the donor area. For the correction of secondary stenoses, the author occassionally uses composite grafts from the interior aspect of the auricular crus helicis.