Reconstruction of medium and large nasal defects.

Objective: The aim of this study is to share our experience with nasal reconstruction and to give a standardized algorithm for nasal reconstruction. Study Design: Descriptive cross sectional. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2022. Material & Methods: Data was obtained from patient records after approval from IREB. Patients with multiple co-morbidities and small defects (<1.5cm) were excluded from this study. Defects were classified based on anatomic areas of radix, dorsum, sidewall, alar and lower third nasal defects. Cases were cross tabulated regarding site for the reconstructive options to generate the treatment algorithm. Results: A total of 51 cases were included in the study including 30 (58.8%) male patients. Mean age of patients was 48.12+21.89SD. Skin malignancies were the most common (n=35, 68.6%). Nasal ala was the most common site reconstructed in our study (25.5%) followed by nasal dorsum and sidewalls. Medium size (41.2%) was the most common. In 64.8% (n=33) cases, forehead based flaps were used to reconstruct the nasal defects (Table-I). In 5.9% cases we observed flap congestion. In 19 (37.25%) cases, patients presented with additional soft tissue defects which needed reconstruction (Table-II). Reconstructive options are presented as an algorithm based on the defect site (Figure-1). Conclusion: In this study we shared our experience with the readers regarding reconstruction of the nasal detects. We have formulated an algorithm for reconstruction of these defects that will simplify reconstruction in such cases.