A practical approach to nasal reconstruction in Asian patients

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: Nasal surgical procedures; Nose; Reconstructive surgical procedures; Surgical flaps.

Fig. 1.

Causes of nasal defects.

Fig. 2.

Locations of nasal defects.

Fig. 3.

Methods of reconstruction for nasal defects.

Fig. 4.

Nasal reconstruction with a rotation flap. (A) A 73-year-old woman after ablation of basal cell carcinoma. (B) One week after surgery.

Fig. 5.

Nasal reconstruction with a nasolabial advancement flap. (A) An 83-year-old woman after ablation of basal cell carcinoma on the right ala. (B) Two weeks after surgery.

Fig. 6.

A 50-year-old woman after subtotal necrosis of the distal nose. (A) Frontal view and (B) profile view. (C) Nasal reconstruction with a paramedian forehead flap. (D) Six months after surgery: final view of the same patient.

Fig. 7.

A 19-year-old man after traumatic loss of the distal nose. (A) Preoperative photography. (B) Nasal reconstruction with a converse scalping flap. (C) One month after surgery.

Fig. 8.

Simple algorithm for nasal reconstruction of Asians.

Fig. 9.

Postoperative complications in nasal reconstruction.