Management of Full-Thickness Nasal Defects

The nose is one of the most noticeable parts of the face, and reconstruction encompasses modifications that are not well hidden. The three-dimensional protrusion of the nose affords only small structural alterations to reduce any complications. Therefore, restoration of an imperfection is challenging due to the aforementioned reasons. Surgery consultation comprises of the malformation assessment as well as an open dialogue with the patient about any apprehensiveness or specific questions about the procedure or end result. Numerous features must be considered for the reconstruction process, including color, texture, contouring, and functionality. For small (<1.5 cm) zone 1 defects, there are multiple options. For large ones, a forehead flap is useful for the dorsal and sidewall subunits. For the sidewall, a melolabial flap is a good choice. Zone 2 defects may be complex to repair due to the nasal tip prominence. The skin grafting is difficult and mostly acquired from the forehead or adjacent area. Bilobed flaps, full-thickness grafts from the forehead can be used. For larger defects in zone 3, there are many options of reconstruction. The radial forearm flap is commonly used and is based on the radial artery and vein as well as some soft tissue. This method can be used to restructure the nasal coating or for a total reconstruction. In this chapter, management of full-thickness nasal defects is presented.