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Patient Assessment of Psychosocial Dysfunction following Nasal Reconstruction

Pepper, Jon-Paul M.D.; Asaria, Jamil M.D.; Kim, Jennifer C. M.D.; Baker, Shan R. M.D.; Moyer, Jeffrey S. M.D.

Plastic and Reconstructive Surgery: February 2012 - Volume 129 - Issue 2 - p 430–437
doi: 10.1097/PRS.0b013e31823aeb0a
Reconstructive: Head and Neck: Original Articles

Background: Postoperative psychosocial distress is a critical aspect of surgery, particularly in aesthetically sensitive areas. In this study, the authors assess the level of psychosocial distress associated with nasal reconstruction. The authors also compare postoperative distress levels associated with different reconstructive techniques throughout the healing process.

Methods: The authors conducted a prospective study of patients undergoing nasal reconstruction following excision of cutaneous malignancy. The main outcome measure was the Derriford Appearance Scale 24, a measure of psychosocial distress. The Derriford Appearance Scale was administered at preoperative assessment, 1 < x < 4 weeks, 4 ≤ x < 12 weeks, and x ≥ 12 weeks. The entire cohort was analyzed with respect to distress levels before and after surgery. Reconstructions were categorized as interpolated, local tissue, or full-thickness skin graft. Analyses were performed for reconstruction type, patient, and defect data.

Results: Fifty-nine patients were enrolled. Reconstructions included 14 interpolated flaps, 17 local tissue flaps, and 28 full-thickness skin grafts. For the entire cohort, distress levels were significantly higher at the first postoperative visit (p < 0.05), with normalization at subsequent follow-up evaluations. At the first assessment, the interpolated flap group had significantly higher levels of distress in comparison with the full-thickness skin graft group (p < 0.05). At late follow-up, levels of distress were equivalent.

Conclusions: Nasal reconstruction is associated with short-term increases in psychosocial distress that corrects by approximately 12 weeks after surgery. Interpolated flaps cause significantly higher distress at early assessment. Distress levels at late follow-up appear to be equivalent to those following a full-thickness skin graft despite larger and deeper initial defects.


Livonia, Mich.

From the Department of Otolaryngology–Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Michigan Medical Center.

Received for publication April 3, 2011; accepted July 27, 2011.

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

Jon-Paul Pepper, M.D.; Department of Otolaryngology–Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Michigan Medical Center, 19900 Haggerty Road, Suite 103, Livonia, Mich. 48152,

©2012American Society of Plastic Surgeons