Nasal reconstruction after malignant tumor resection: an algorithm for treatment.
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.
Moolenburgh
Sanne E
SE
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.
McLennan
Linda
L
Levendag
Peter C
PC
Munte
Kai
K
Scholtemeijer
Marcel
M
Hofer
Stephan O P
SOP
Mureau
Marc A M
MAM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000601:surgery; D002356:Cartilage / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D009667:Nose Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D009669:Nose Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult