A young child with a badly deformed nose is a dilemma to a plastic surgeon. There is an impulse to rebuild the nose; however, confusion exists regarding the optimal technique.
The forehead flap achieves excellent aesthetic and functional results, has acceptable donor-site morbidity, and grows as the patient grows. The donor site heals well in children because of the nonsebaceous quality of their forehead skin; however, some scars may require revision. Only the forehead flap can eliminate a substantial nasal deformity and create a nearly normal or normal appearance that enables the child to grow and develop normally without the stigma and psychological insult a nasal deformity bestows.
The methods above are further illustrated in a case example of a 9.6-year-old female pediatric patient. This young girl is one of a series of 25 pediatric nasal reconstruction cases to appear in a forthcoming comprehensive book on the subject. In this patient, a forehead flap was an appropriate option to eliminate her deformity. Reshaping the nose with small local flaps, cartilage grafts, and/or composite grafts would merely have softened her deformity and never eradicated it.
Use of a forehead flap and cartilage grafts does not automatically create a normal, aesthetic nose, especially for a child. Correct framework, form, and dimension are required, or the result will be merely a new but different deformity. Creation of a nose requires artistic and surgical ability, and can be learned by careful study of the technical aspects and artistry of aesthetic nasal reconstruction in children.
From the Department of Surgery, Section of Plastic Surgery, University of Chicago.
Received for publication October 30, 2008; accepted February 20, 2009.
Gary C. Burget, M.D.; 2913 N. Commonwealth Avenue, Suite 400; Chicago, Ill. 60657-6224; firstname.lastname@example.org
Disclosure:The author has no financial interest to declare in relation to the content of this article.
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