Comprehensive reconstruction of the external nose

Nasal defects can take place most often after oncological procedures or traumatic avulsions. Substance abuse is a more and more frequent cause of severe nasal deformities. Rarely even congenital diseases such as arhinia can lead to the need of complex nasal reconstructions. Whereas small defects of the skin are easily repaired with local flaps, more complex reconstructions must address the inner lining, the outer lining and the skeletal framework to obtain ideal results. The inner lining can be successfully reconstructed with mucosal flaps from the septum or the turbinate. Alternatively a previously skin-grafted forehead flap is usually sufficient. Major defects of the inner lining on the other hand require microvascular flaps. The workhorse of major reconstructions of the nasal skin is the forehead flap. It is ideal in terms of color and texture match, it is extremely reliable and if some technical aspects are respected, the results that are obtained are predictable. The reconstruction of the skeletal and cartilaginous framework is of the uttermost importance. Minor defects are easily reconstructed with small cartilaginous grafts harvested from the septum or the ear. On the other hand, the workhorse for major nasal reconstructions is the rib graft. This allows performing composite bony and cartilaginous reconstructions with enough tissue to rebuild the dorsum and the alae. Here the Authors present their experience with nasal reconstructions in nasal defects resulting from oncological procedures, from substance abuse and in arhinia.