[A nasal reconstruction via the expansion of the tissue]

The techniques that offer the best results in total nasal reconstruction are those that use frontal skin. Even if traditional procedures meet most of the reconstructive needs, they are often limited by the size of the tissues to be transplanted and by the scarring they leave in the donor area. The stiffness and scarce pliability of the frontal skin hinder fine modelling of the alae, of the columella and of the nasal tip. Expanded forehead flaps to day offer a substantial advantage. In the period from 1986 to 1991 total nasal reconstruction was performed in 12 patients (4 males and 8 females). Their ages ranged from 4 to 69 years. Four patients presented a recurrence of a basal cell carcinoma, 1 patient presented a trichoepithelioma. In 3 cases an arteriovenous vascular malformation was present, in 1 there were radiodermatitic lesions while in another 3 cases there was extensive scarring. In all cases a rectangular skin expander without base and with a remote filling port was used. The nominal volume ranged from 100 cc to 260 cc. All expanders were introduced through a vertical hair incision in the subgaleal plane, except in 1 case in which it was placed over the frontal muscle. The mean time of expansion was 79 day. The mean volume at the end of the expansion was 283 cc. The results obtained are presented and the advantages of the technique are exposed. These are: 1) the possibility of obtaining forehead flaps wide enough to cover large defects, 2) the direct closure of the donor area even if large flaps are raised, and 3) the improved pliability of the expanded frontal skin. A minor complication present in all the patients treated was moderate pain during inflation of the expander, easily controlled with common analgesics. A bony crest was frequently observed around the base of the skin expander which, however, was easily removed with a curette. Only in one case was a major complication observed; that of a preoperative infection necessitating removal of the expander, which was reapplied a few months later in order to complete the initial reconstructive program.