Reconstruction of superficial defects from the crossroad of nasal subunits, tip, alar lobule and lateral side wall: Study of 36 patients

Conventionally, articles dealing with nasal defects plan reconstructions regarding the aesthetic subunits, imposing their systematic respect. We propose to study the reconstruction of a crossroad region of three subunits, tip, alar lobule and lateral sidewall, where that full compliance is not possible, in our experience of 36 patients. Our retrospective study from January 2011 to December 2012 focused on patients with a defect in this crossroad region that was repaired by skin graft or flap. We described the population of the study, histological type of the lesions, surgical procedures and complications. We evaluated the reconstructions performed with a photographic review 1 year post-surgery according to the criteria of symmetry, discoloration, thickness, shrinkage, and rating on the Vancouver Scar Scale, which helped create an overall aesthetic score for the reconstruction. Of 144 patients with a nasal defect, 36 of them (25%) were included, presenting a defect in our study area. The reconstruction was made by eight hatchet flaps, eight frontal flaps, seven bilobed flaps, five advanced-rotated lateronasal flaps, four nasolabial flaps, two Rybka flaps and two total skin grafts. The advanced-rotated flap, hatchet flap and bilobed flap had the highest results and scores, according to the criteria assessed. Rybka flap and total skin grafts had the lowest results. The occurrence of a defect in the crossroads seems common. In this indication, specific local flaps had a favourable outcome, including review of the overall esthetic score which was created to standardize the assessment of reconstructions.