Choosing Appropriate Technique for Nasal Reconstruction in Challenging Cases of Panfacial Burn: Treatment Algorithm

The nose is one of the most challenging facial parts to reconstruct. Its asymmetries, defects, or disharmonies are easily noticeable. The complex contours, highlights, shadows, and special shape of its subunits make nasal reconstruction more difficult in panfacial burn than that of nonburned ones. This retrospective study was conducted at Zare Hospital. Twenty-five panfacial burn cases with nasal defects were studied from 2010 to 2019. Profile photos were manipulated by Adobe Photoshop. Based on the difference between the burn-related shortened nasal length and the expected photoshopped one, the severity of the short nose was detected, and the strategy of the surgery was determined. Of the 25 cases, 10 cases with normal nasal length and projection, or mild short nose with minimal alar rim, tip and/or columellar defect underwent nasal reconstruction with skin and/or composite graft. Nine patients with normal nasal length or mild to moderate short nose but moderate to severe alar defect underwent reconstruction with turndown flap plus skin and/or composite graft. Pre-expanded forehead flap (n = 1) and delayed scarred or skin grafted forehead flap (n = 5) were used for six patients with severe short nose defect. There are several procedural alternatives for the reconstruction of burn-related mild to moderate nasal deformity. For severe and deep panfacial burn, delayed forehead flap seems safe with acceptable color and texture harmony. Our designed algorithm could potentially improve the selection of proper nasal reconstruction techniques and assist novice surgeons.