Nasal reconstruction based on aesthetic subunits in Orientals

Reconstruction based on the aesthetic subunit principle has yielded good ae sthetic outcomes in patients with moderate to severe nasal defects caused b y trauma or tumor resection. However, the topographic subunits previously p roposed are often unsuitable for Orientals. Compared with the nose in white patients, the nose in Orientals is low, lacks nasal muscle, and has a flat glabella; the structural features of the underlying cartilage and bone are not distinctly reflected in outward appearance. The authors devised aesthetic subunits suitable for Orientals, and they use d these units to reconstruct various parts of the nose. The major differenc e between these units and those presented previously is the lack of soft tr iangles and the addition of the glabella as an independent unit. The author s divided the nose into the following five topographic units: the glabella, the nasal dorsum, the nasal tip, and the two alae. The border of the nasal dorsum unit was extended to above the maxillonasal suture. The basic recon struction techniques use a V-Y advancement flap from the forehead to recons truct the glabella, an island flap from the forehead to reconstruct the nas al dorsum and nasal tip, a nasolabial flap to reconstruct an ala, and a mal ar flap to reconstruct the cheek. A combination of flaps was used when the defect involved more than one unit. This concept was used for nasal reconstruction in 24 patients. In one patie nt undergoing reconstruction of the nasal dorsum and in one undergoing reco nstruction of the nasal tip, the texture of the forearm flap did not match well, which resulted in a slightly unsatisfactory aesthetic outcome. In one patient in whom the glabella, nasal dorsum, and part of the cheek were rec onstructed simultaneously, a web was formed at the medial ocular angle, and a secondary operation was subsequently performed using Z-plasty. In one pa tient undergoing reconstruction with a forehead flap, defatting was require d to reduce the bulk of the subcutaneous flap pedicle at the glabella. Howe ver, suture lines were placed in the most inconspicuous sites in all patien ts, and the use of a trapdoor contraction emphasized the three-dimensional appearance of the nose. The use of these aesthetic subunits for reconstruction offers several advan tages, particularly in Oriental patients. Because the nasal dorsum is recon structed together with the side walls, tenting of the nasal dot-sum is avoi ded, which prevents a flat appearance of the nose. A forehead flap is usefu l in the repair of complex defects. Defects of the alae should be separatel y reconstructed with a nasolabial flap to enhance the effect of the trapdoo r contraction and to highlight the three-dimensional appearance of the nose . Candidates for reconstruction should be selected on the basis of nasal st ructure. The results suggest that these units can also be used in some whit e patients.