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Nasal Reconstruction after Malignant Tumor Resection: An Algorithm for Treatment

Moolenburgh, Sanne E. M.D., Ph.D.; McLennan, Linda M.D.; Levendag, Peter C. M.D., Ph.D.; Munte, Kai M.D., Ph.D.; Scholtemeijer, Marcel M.D., Ph.D.; Hofer, Stephan O. P. M.D., Ph.D.; Mureau, Marc A. M. M.D., Ph.D.

Plastic & Reconstructive Surgery: July 2010 - Volume 126 - Issue 1 - pp 97-105
doi: 10.1097/PRS.0b013e3181da872e
Reconstructive: Head and Neck: Original Articles

Background: Seventy-five percent of nonmelanoma skin cancers are located in the head and neck area, of which 30 percent occur on the nose (225,000 new cases per year). The aim of this study was to develop a nasal reconstruction algorithm for nasal defects, based on experience with 788 consecutive nasal reconstructions performed in a multidisciplinary university medical center setting over a period of 7 years.

Methods: Medical files of 788 consecutive patients who were operated on for various nasal pathologies between January of 2001 and December of 2008 were reviewed. In addition, a literature search on treatment of nasal defects and outcomes after nasal reconstruction was conducted using PubMed.

Results: The algorithm divides nasal defects into simple, small (skin only), larger (skin and cartilage), or full thickness. Small defects can be closed primarily or with various local flaps. For larger defects, the three-stage paramedian forehead flap is the flap of choice with or without the use of cartilage grafts. For small inner lining defects, full-thickness skin grafts or turn-down lining flaps with delayed primary cartilage grafts at the intermediate stage are currently the authors' preference. For medium to larger inner lining defects, the folded forehead flap with delayed primary cartilage grafts at the intermediate stage is the authors' preferred technique. For (sub)total nasal reconstructions with very large inner lining requirements, the authors would now consider free vascularized tissue transfer.

Conclusions: Nasal skin cancer is an increasing problem. Proper treatment of nasal skin cancer, including nasal reconstruction, requires a structured multidisciplinary approach to achieve excellent tumor control and a satisfactory aesthetic and functional end result.

Rotterdam, The Netherlands; and Toronto, Ontario, Canada

From the Departments of Plastic and Reconstructive Surgery, Dermatology, and Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center; Division of Plastic Surgery, University Health Network, University of Toronto; and Department of Radiation-Oncology, Daniel den Hoed Cancer Center.

Received for publication August 30, 2009; accepted January 11, 2010.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Marc A. M. Mureau, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands, m.mureau@erasmusmc.nl

©2010American Society of Plastic Surgeons