A Decade's Experience: A Sound Framework as the Foundation to Nasal Reconstruction

The goal of nasal reconstruction surgery is to restore normal nasal shape and function, and its success begins with creating a stable framework. In this article the authors discuss the most advantageous materials for building such a framework and how to design this element to achieve better and more durable outcomes. This is a retrospective study including patients who underwent nasal reconstruction in our rhinoplasty and nasal reconstruction center at a tertiary referral hospital between 2006 and 2016. Data included patient characteristics, defect location, the reason for defect, use of supporting structure, flap, lining, and complications were recorded. The minimum postoperative follow-up was at least 6 months after the last operation. This study included 455 patients. Nasal defects treated most commonly involved zone 2 and an average defect of 4.2 subunits. Expanded forehead flap for cover with costal cartilage as a framework and turn-over flap combined with distal end of the flap for lining was the most common reconstruction method used in this study. The complication rate was 4.39% and nearly half of these complications were related to usage of an expander during reconstruction. Regardless of flap used, the supporting structure was the most critical element for the 3-dimensional shape of the reconstructed nose. As 1 of the 3 elements of nasal reconstruction, framework deserves adequate attention during such reconstruction.