Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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A practical approach to nasal reconstruction in Asian patients

  • Koh, In Suk (Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, Inje University School of Medicine) ;
  • Sun, Hook (Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, Inje University School of Medicine)
  • Received : 2021.09.25
  • Accepted : 2021.10.20
  • Published : 2021.10.20
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Abstract

Background: The study aimed to evaluate nasal reconstruction techniques customized for Asians. The currently available nasal reconstruction guidelines are based on Caucasian patients, and their applicability is limited in Asian patients due to differences in anatomical and structural features. Methods: A retrospective analysis was performed of the medical records of 76 patients who underwent nasal reconstruction at a single center between January 2010 and June 2020. A comprehensive evaluation was conducted of patients' baseline demographics and clinical characteristics, including age, sex, medical history, defect size and location, reconstructive procedure, pathological diagnosis, postoperative complications, and recurrence. Results: In 59 cases (77%), nasal defects resulted from tumor ablation, and the remaining 17 cases involved post-traumatic (20%) and infection-induced (3%) tissue damage. The most common defect location was the alae, followed by the sidewalls, tip, and dorsum. Forehead flaps were the most commonly used reconstructive technique, followed by nasolabial advancement flaps, rotation flaps, and skin grafts. Each procedure was applied considering aspects of structural anatomy and healing physiology specific to Asians. Complications included nasal deformity, hypertrophic scarring, secondary infection, and partial flap necrosis, but no cases required additional surgical procedures. Tumors recurred in two cases, but tumor recurrence did not significantly affect flap integrity. Conclusion: Nasal reconstruction techniques applied considering Asians' facial features resulted in fewer postoperative complications and higher patient satisfaction than the approaches that are currently in widespread use. Therefore, this study is expected to serve as an essential reference for establishing treatment guidelines for nasal reconstruction in Asians.

Keywords

References

  1. Park YJ, Kwon GH, Kim JO, Ryu WS, Lee KS. Reconstruction of nasal ala and tip following skin cancer resection. Arch Craniofac Surg 2019;20:382-7. https://doi.org/10.7181/acfs.2019.00486
  2. Hsiao YC, Chang CS, Zelken J. Aesthetic refinements in forehead flap reconstruction of the Asian nose. Plast Surg (Oakv) 2017;25:71-7. https://doi.org/10.1177/2292550317694853
  3. Burget GC, Menick FJ. Aesthetic reconstruction of the nose. 2nd ed. St. Louis: Mosby; 1992.
  4. Shaffer JJ, Taylor SC, Cook-Bolden F. Keloidal scars: a review with a critical look at therapeutic options. J Am Acad Dermatol 2002;46(2 Suppl Understanding):S63-97. https://doi.org/10.1067/mjd.2002.120788
  5. Nouveau-Richard S, Yang Z, Mac-Mary S, Li L, Bastien P, Tardy I, et al. Skin ageing: a comparison between Chinese and European populations: a pilot study. J Dermatol Sci 2005;40:187-93. https://doi.org/10.1016/j.jdermsci.2005.06.006
  6. Ho SG, Chan HH. The Asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases. Am J Clin Dermatol 2009;10:153-68. https://doi.org/10.2165/00128071-200910030-00002
  7. Yotsuyanagi T, Yamashita K, Urushidate S, Yokoi K, Sawada Y. Nasal reconstruction based on aesthetic subunits in Orientals. Plast Reconstr Surg 2000;106:36-44. https://doi.org/10.1097/00006534-200007000-00006
  8. Toriumi DM, Swartout B. Asian rhinoplasty. Facial Plast Surg Clin North Am 2007;15:293-307. https://doi.org/10.1016/j.fsc.2007.04.003
  9. Kim JH, Song JW, Park SW, Oh WS, Lee JH. Tip extension suture: a new tool tailored for Asian rhinoplasty. Plast Reconstr Surg 2014;134:907-16. https://doi.org/10.1097/PRS.0000000000000656
  10. Menick FJ. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plast Reconstr Surg 2002;109:1839-55. https://doi.org/10.1097/00006534-200205000-00010
  11. Burget GC. Aesthetic restoration of the nose. Clin Plast Surg 1985;12:463-80. https://doi.org/10.1016/s0094-1298(20)31673-4
  12. Antia NH, Daver BM. Reconstructive surgery for nasal defects. Clin Plast Surg 1981;8:535-63. https://doi.org/10.1016/s0094-1298(20)30424-7
  13. Baker SR. Regional flaps in facial reconstruction. Otolaryngol Clin North Am 1990;23:925-46. https://doi.org/10.1016/s0030-6665(20)31218-4
  14. Kazanjian VH. The repair of nasal defects with the median forehead flap: primary closure of forehead wound. Surg Gynecol Obstet 1946;83:37-49.
  15. Beer GM, Bermoser K, Kompatscher P. Closure of nasal defects after tumor excision with local flaps. Aesthetic Plast Surg 1998;22:42-7. https://doi.org/10.1007/s002669900164
  16. Kim TK, Jeong JY. Surgical anatomy for Asian rhinoplasty: part II. Arch Craniofac Surg 2020;21:143-55. https://doi.org/10.7181/acfs.2020.00234
  17. Park J, Suhk J, Nguyen AH. Nasal analysis and anatomy: anthropometric proportional assessment in Asians-aesthetic balance from forehead to chin, part II. Semin Plast Surg 2015;29:226-31. https://doi.org/10.1055/s-0035-1564818
  18. Larnier C, Ortonne JP, Venot A, Faivre B, Beani JC, Thomas P, et al. Evaluation of cutaneous photodamage using a photographic scale. Br J Dermatol 1994;130:167-73. https://doi.org/10.1111/j.1365-2133.1994.tb02895.x
  19. Chanprapaph K, Tanrattanakorn S, Wattanakrai P, Wongkitisophon P, Vachiramon V. Effectiveness of onion extract gel on surgical scars in Asians. Dermatol Res Pract 2012;2012:212945. https://doi.org/10.1155/2012/212945
  20. Salgarelli AC, Bellini P, Multinu A, Magnoni C, Francomano M, Fantini F, et al. Reconstruction of nasal skin cancer defects with local flaps. J Skin Cancer 2011;2011:181093.
  21. Zitelli JA, Fazio MJ. Reconstruction of the nose with local flaps. J Dermatol Surg Oncol 1991;17:184-9. https://doi.org/10.1111/j.1524-4725.1991.tb01613.x
  22. Lim J, Oh J, Eun S. Flap reconstruction of soft tissue defect after resecting a huge hemangioma of the nose. Arch Craniofac Surg 2020;21:69-72. https://doi.org/10.7181/acfs.2019.00668
  23. Konofaos P, Alvarez S, McKinnie JE, Wallace RD. Nasal reconstruction: a simplified approach based on 419 operated cases. Aesthetic Plast Surg 2015;39:91-9. https://doi.org/10.1007/s00266-014-0417-0
  24. Larrabee WF Jr, Sherris DA. Principles of facial reconstruction. 2nd ed. Philadelphia: Lippincott-Raven; 1995.
  25. Little SC, Hughley BB, Park SS. Complications with forehead flaps in nasal reconstruction. Laryngoscope 2009;119:1093-9. https://doi.org/10.1002/lary.20243
  26. Kim YH, Yoon HW, Chung S, Chung YK. Reconstruction of cutaneous defects of the nasal tip and alar by two different methods. Arch Craniofac Surg 2018;19:260-3. https://doi.org/10.7181/acfs.2018.02271