Nose reconstruction
Nose Reconstruction
Dr Khosh excels in Manhattan nose reconstruction that result from excision of skin tumors. Nasal defects can be confined to the skin, or they can extend through the cartilage to inside the nose. Defects which extend into the nose represent the most challenging reconstructions. In those circumstances, not only the skin, but also the structural support and the inner lining must be refashioned.
In considering reconstruction for a nose defect, the size, the depth, and the general condition of the patient play important roles. When a defect is confined to one side of the nose, the other side can be used as a template for reconstruction. If the defect causes bilateral deficit in the nose, old photographs can be used as a guide in reconstruction.
Small to medium sized defects of the nose can be repaired with a bilobed flap, where adjacent nasal skin is transferred into the defect site. The following patient was reconstructed in this manner. As you can see, the repaired defect is hardly noticeable.
Larger defects, especially those involving the nasal tip are best treated with a paramedian forehead flap ( a vertical flap of forehead tissue taken from the midline). This is a two staged procedure staggered over two weeks. In the first stage, skin and muscle from the midline of the forehead is transferred to the nose, while preserving a bridge of tissue which contains the blood supply to the flap. Two weeks later, the vascular bridge is severed and the wounds are repaired.
The paramedian forehead flap was used in the following patient to repair a large nasal tip defect. The only visible sign from the forehead donor site is a well healed vertical scar. This flap does not affect sensation or mobility of the forehead.
In cases where the skin defect is confined to the nostril rim, tissue flaps from the medial cheek (melolabial flap) work extremely well. The melolabial flap is preformed as a two staged flap, like the forehead flap. The following patient had a basal cell carcinoma excised by Mohs’ technique with a resultant deep nostril rim defect. The melolabial flap was used with outstanding results.
Since there are usually multiple options available for repair of each nasal defect, Dr Khosh uses such considerations as the general health of the patient, defect size and depth, and tissue availability from various donor sites, in arriving at the most suitable reconstructive option.
Manhattan Nose Reconstruction: 212-223-1333
