Indikation und Wertigkeit verschiedener Techniken zur Nasenflügelrekonstruktion*

Zusammenfassung

Die Rekonstruktion des Nasenflügels stellt eine häufige Aufgabe der wiederherstellenden Chirurgie dar. Eine Vielzahl verschiedener Methoden wurde hierfür entwik-kelt. Bei allen Planungen von rekonstruktiven Maßnahmen im Gesicht ist es aber von entscheidender Bedeutung, dass nicht nur eine Wiederherstellung der Funktion erfolgt, sondern dass damit auch ein gutes ästhetisches Ergebnis erreicht wird. Verschiedene Methoden der Nasenflügelrekonstruktion werden deshalb nach diesen Gesichtspunkten gegeneinander abgewogen.

Summary

Reconstruction of the ala of the nose is a very common task for the plastic surgeon. Many different techniques are available, but as in all reconstructive procedures in the face it is important to consider the combination of function and aesthetics. It is not only important to close the defect, but how it looks afterwards. According to these criteria the various methods were analysed and local flaps were found to be the most favorable technique due to their identical texture and colour match to the surrounding tissue. On the nose, the skin of the tip and the ala is very tight which makes it difficult to use local flaps there. However, there is a surplus and looseness of skin in the glabella region. This skin can be transferred by an axial fronto-nasal flap, pedicled on a branch of the angular artery as described by Marchac. With this flap any point of the nose can be reached. In our opinion, this flap appears preferable to all others. The new technique of ala reconstruction based on this axial fronto-nasal flap is demonstrated. The skin defect is covered by this flap and for the inner lining a mucosal flap from the septum can be used which includes a strip of cartilage for stabilisation. In addition the surplus of tissue at the point of rotation, which normally has to be resected as a Burow's triangle, can also be used for the inner lining.

Schlüsselwörter

Nasenrekonstruktion - Hauttransplantat - Zusammengesetztes Haut-Knorpeltransplantat - Nahlappen - Fernlappenplastik

Key words

Nose reconstruction - Skin transplantate - Composite graft - Local flap - Transposition flap