REPLANTATION OF THE AMPUTATED NOSE

Objective: To assess the effectiveness of replantation in the treatmen t of nasal amputations. Design: Retrospective chart review. Setting: A university medical center. Results: In no case did the replant surviv e completely, and in all cases revision surgery was required. However, in all cases, the resulting deformity was less than the original defe ct. In our pediatric patients, reconstruction with cartilage grafting and a midline forehead flap was successful and demonstrated proportion ate and appropriate growth. Conclusions: It is our belief that replant ation serves many therapeutic functions. At the very least, there is t he psychological/emotional factor that is involved in attempting to re place a native body part that has been severed. Also, it is difficult to persuade parents and patients that the amputated tissue that has be en handled with kid gloves by paramedics, maintaining its pink ''alive '' color, is ultimately doomed to failure. Forehead flaps and conchal cartilage grafts are more willingly accepted after a ''failed'' replan tation than as primary reconstructions. In every instance, we believe, the ultimate defect will be smaller than the original deformity. Cert ainly, the need for vestibular lining reconstruction is far less. Thus , the ultimate healed defect from the replantation greatly facilitates final nasal reconstruction.