The nose is lined with a thin, vascular mucosal epithelium, which is strongly adherent to the underlying osseous and cartilaginous tissues of the nose. The strength of this attachment to the underlying structures imposes limits on how much the mucosa can move, thus rendering 5 mm the maximum diameter of deficits which can close by primary intention. Burget outlined beautifully the principles supporting the practice of nasal reconstruction in his 1985 work. This work extends the framework of plastic surgery essentials on which surgical outcomes of the highest order depend.
The principles underlying replacement are that deficits need to be substituted with tissue of a similar kind and similar amount. For example, relining of the nose needs to involve lining mucosa, cartilaginous tissue can replace cartilage, osseous tissue can replace bone, and donor site skin needs to resemble the missing skin in coloration and texture. The author has a preference for skin flaps rather than skin grafts precisely because of their better fit in terms of coloration and texture, their ability to resist contracting, and their ability to ensure a vascularized lining for the nasal skeletal elements. Nasal skin should ideally be replaced with other skin from the nose, provided a suitable donor site exists. Skin flaps ought to be the first choice since their advantages in terms of color and texture matching are greater than the drawback of extra scar formation. Template use is to be advised. When recreating lost sections, the nose as normally found offers a three-dimensional template to follow. Materials which are of a sufficient balance between rigidity and flexibility are essential for forming a template: suture packaging materials fits the bill well.
KeywordsInner lining reconstruction Nose Maximum diameter Deficit Template
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