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Nasal reconstruction after malignant tumor resection: an algorithm for treatment
Sanne E Moolenburgh1, Linda McLennan, Peter C Levendag
1Rotterdam, The Netherlands; and Toronto, Ontario, Canada From the Departments of Plastic and Reconstructive Surgery, Dermatology, and Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center; Division of Plastic Surgery, University Health Network, University of Toronto; and Department of Radiation-Oncology, Daniel den Hoed Cancer Center.
Background:
Seventy-five percent of nonmelanoma skin cancers are located in the head and neck area, of which 30 percent occur on the nose (225,000 new cases per year). The aim of this study was to develop a nasal reconstruction algorithm for nasal defects, based on experience with 788 consecutive nasal reconstructions performed in a multidisciplinary university medical center setting over a period of 7 years.
Methods:
Medical files of 788 consecutive patients who were operated on for various nasal pathologies between January of 2001 and December of 2008 were reviewed. In addition, a literature search on treatment of nasal defects and outcomes after nasal reconstruction was conducted using PubMed.
Results:
The algorithm divides nasal defects into simple, small (skin only), larger (skin and cartilage), or full thickness. Small defects can be closed primarily or with various local flaps. For larger defects, the three-stage paramedian forehead flap is the flap of choice with or without the use of cartilage grafts. For small inner lining defects, full-thickness skin grafts or turn-down lining flaps with delayed primary cartilage grafts at the intermediate stage are currently the authors' preference. For medium to larger inner lining defects, the folded forehead flap with delayed primary cartilage grafts at the intermediate stage is the authors' preferred technique. For (sub)total nasal reconstructions with very large inner lining requirements, the authors would now consider free vascularized tissue transfer.
Conclusions:
Nasal skin cancer is an increasing problem. Proper treatment of nasal skin cancer, including nasal reconstruction, requires a structured multidisciplinary approach to achieve excellent tumor control and a satisfactory aesthetic and functional end result.
Insights
This study presents a nasal reconstruction algorithm for various nasal defects, guiding treatment from simple skin loss to total reconstruction. The algorithm ensures optimal tumor control and aesthetic outcomes for nasal skin cancer patients.
Area of Science:
- Plastic Surgery
- Dermatology
- Oncology
Background:
- Nonmelanoma skin cancers frequently occur on the head and neck, with a significant proportion affecting the nose.
- Nasal defects pose a reconstructive challenge, necessitating effective treatment algorithms.
Purpose of the Study:
- To develop a structured algorithm for nasal reconstruction based on a large cohort.
- To guide the management of diverse nasal defects resulting from skin cancer and other pathologies.
Main Methods:
- Retrospective review of 788 nasal reconstructions performed between 2001 and 2008.
- Literature search using PubMed for nasal defect treatment and reconstruction outcomes.
Main Results:
- The algorithm categorizes defects into simple, small (skin), larger (skin/cartilage), or full thickness.
- Reconstruction strategies include primary closure, local flaps, paramedian forehead flaps, skin grafts, and free tissue transfer.
- Specific techniques are recommended for inner lining defects and total nasal reconstruction.
Conclusions:
- Nasal skin cancer is a growing concern requiring a structured, multidisciplinary approach.
- Effective nasal reconstruction is crucial for achieving excellent oncological, functional, and aesthetic results.