[Nasal reconstruction: Decision tree based on 229 operated cases]

Area of Science:

• Plastic Surgery
• Dermatology
• Oncology

Background:

• Cutaneous carcinoma frequently affects the face, with the nose being a common site (approximately 30% of facial tumors).
• Nasal defect reconstruction must address oncologic, aesthetic, and functional objectives.
• Effective reconstruction techniques are crucial for restoring form and function after tumor excision.

Purpose of the Study:

• To develop a decision tree for selecting surgical reconstruction techniques for nasal defects.
• To guide surgeons in choosing appropriate methods based on defect size and location.
• To optimize outcomes in nasal reconstruction following cutaneous carcinoma removal.

Main Methods:

• Retrospective analysis of 229 patients undergoing nasal reconstruction from 2013-2019.
• Evaluation of reconstruction types, tissue defect size, and defect location within nasal aesthetic subunits.
• Analysis correlated defect characteristics with chosen surgical techniques.

Main Results:

• Nose tip defects were most frequent (32%).
• Skin grafts/composite grafts were used in 44% of cases, while flaps (predominantly local) were used in 56%.
• Specific flaps (Rybka, bilobed, Rieger, forehead, island) and grafts were detailed for different nasal subunits and defect sizes.

Conclusions:

• A novel decision tree was developed based on extensive experience in nasal reconstruction.
• The decision tree assists surgeons in selecting optimal reconstruction techniques tailored to defect size and location.
• This approach aims to improve results in nasal reconstruction for cutaneous malignancies.