Repair Of Full-Thickness Nasal Defects:A Clinical Study Of 49 Cases

Objective:To discuss the clinical usage of different repair methods in different kind of nasal defects.Method:Medical records of patients with nasal defects caused by various reasons admitted to our department from January 1993 to December 2019 were reviewed.A total of 49 patients with full-thickness nasal defects were included in the study consisted of 29 male and 20 females patients,ranging in age from 6 to 58 years old(27.5±12.5).Causes of defect:Six defects were caused by tumor resection;one caused by infection;twenty-two caused by trauma;eight patients were congenital malformation;nine were caused by burns;two were caused by hemangioma and one was caused by complications of rhinoplasty surgery.Defect site:Five patients were total nasal defect;Eleven patients were subtotal nasal defect and 33 patients were subunit defect.Surgical methods:Thirty-two patients were repaired by expanded forehead flap.Two cases were repaired by bipedicled forehead flap.Six cases were repaired by modified Tagliacozzi flap.Two cases were repaired by nasolabial flap and seven patients by expanded prelaminated forehead flap.Analysis and evaluation of clinical effects were made according to the defect range,site,donor site and surgical methods.Results:Total grafts survived in 44 patients after surgery and the postoperative nasal shapes were satisfactory.Distal flap necrosis appeared in 4 patients with minor flap loss and the outcomes were acceptable after debridement.Full-thickness flap necrosis occurred in only one patient with expanded forehead flap resulting in infection and contraction and a secondary repair was needed.There were 3 patients presented different levels of nasal obstruction after surgery.Conclusion:The full-thickness nasal defect is difficult to be repaired and many types of surgical methods are available.Many aspects are needed to be considered including defect range,site,donor site and patients’ willing then the optimal choice can be made to reconstruct the lining,support and cutaneous coverage at the same time.What’s more,the nose ventilation function also need doctors’ attention.