Reconstruction of the distal third of the nose: case series and literature review

▪ ABSTRACT

Introduction:

The nose has great aesthetic and functional importance, with a high incidence of malignant lesions. There are several techniques for reconstructing the distal third of the nose, but there is no universal indication; will depend on the characteristics of the injury. Surgical options vary between skin grafts and local, regional, and microsurgical flaps. The objective is to present a series of cases of reconstruction of the distal third of the nose using different surgical techniques, discussing the peculiarities and the results obtained.

Method:

This is a retrospective study carried out at the Hospital do Servidor Público Estadual de São Paulo (HSPE), evaluating a series of eight patients diagnosed with non-melanoma skin cancer located in the distal third of the nose and who underwent reconstruction by the team of Plastic Surgery.

Results:

Satisfactory results were obtained for all patients undergoing distal nose reconstruction, using total skin graft techniques (n=1) and local flaps (n=7), such as the bilobed, nasolabial, and dorsal nose flap. nose, paramedian frontal, and nasolabial transposition.

Conclusion:

Reconstruction of defects in the distal third of the nose is challenging and involves great technical variability. A careful assessment of the patient and the injury must be carried out, risks and benefits assessed and the decision shared with the patient.

Keywords:

Nose neoplasms - Nose - Surgical flaps - Skin transplantation - Reconstructive surgical procedures

Institution: Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil.

Publication History

Received: 31 December 2022

Accepted: 05 December 2023

Article published online:
20 May 2025

• REFERÊNCIAS

• 1 Yildiz K, Gorgulu T, Yesiloglu N, Kelahmetoglu O, Camli MF, Canter HI. Hybrid reconstruction of distal nasal defects. Dermatol Ther 2021; 34 (01) e14734
• 2 Schäfer K, Rudolph C, Cotofana S, Goebeler M, Weyandt G. Large Nasal Defects with Exposed Cartilage: The Folded Transposition Flap as an Innovative Alternative to the Paramedian Forehead Flap. Dermatology 2018; 234 (3-4): 99-104
• 3 Mysore Srinivas V, Kalapurmat Nagabhushanaiah M. Nose Reconstruction Using Local and Regional Flaps: The Challenges and Advantages. J Cutan Aesthet Surg 2021; 14 (01) 77-83
• 4 Moura BB, Signore FL, Buzzo TE, Watanabe LP, Fischler R, Freitas JOG. Nasal reconstruction: an analysis of a series of cases. Rev Bras Cir Plást 2016; 31 (03) 368-372
• 5 Marcasciano M, Tarallo M, Maruccia M, Fanelli B, La Viola G, Casella D. et al. Surgical Treatment with Locoregional Flap for the Nose. Biomed Res Int 2017; 2017: 9750135
• 6 Brasil. Ministério da Saúde. Instituto Nacional do Câncer. Estimativa 2020: incidência do Câncer no Brasil [Internet]. Rio de Janeiro: Instituto Nacional do Câncer; 2019. [acesso17 abr 2022]. Disponível em: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidenciade-cancer-no-brasil.pdf
• 7 Cason RW, Shammas RL, Pyfer BJ, Glener AD, Marcus JR, Cook JL. Cutaneous Reconstruction of the Nasal Distal Third: Alternative Local Flaps for a Complex Region. Plast Reconstr Surg Glob Open 2021; 9 (05) e3444
• 8 Souza MPS, Pessoa SGP, Muniz VV, Rebelo AD, Holanda EF, Pessoa LMGP. Opções de reconstrução após ressecção de tumor de pele nasal. Rev Bras Cir Plást 2019; 34 (Suppl. 3) 50-52
• 9 Konofaos P, Alvarez S, McKinnie JE, Wallace RD. Nasal Reconstruction: A Simplified Approach Based on 419 Operated Cases. Aesthetic Plast Surg 2015; 39 (01) 91-99
• 10 Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985; 76 (02) 239-247
• 11 Marinho CCC, Miranda ML, Lima RC, Rodrigues CJ, Pego KVT, Reis CF. et al. Reconstruction of the nasal subunits after tumor resection. Rev Bras Cir Plást 2021; 36 (02) 156-163
• 12 National Comprehensive Cancer Network. Basal Cell Skin Cancer (Version 2.2022) [Internet]. 2022 [acesso 4 abr 2022]. Disponível em: https://www.nccn.org/
• 13 National Comprehensive Cancer Network. Squamous Cell Skin Cancer (Version 2.2022) [Internet]. 2022 [acesso 2 de abr 2022]. Disponível em: https://www.nccn.org/
• 14 Rohrich RJ, Griffin JR, Ansari M, Beran SJ, Potter JK. Nasal reconstruction--beyond aesthetic subunits: a 15-year review of 1334 cases. Plast Reconstr Surg 2004; 114 (06) 1405-1416 ; discussion 1417-9
• 15 Sadick H, Häussler D, Rotter N. [Options for reconstruction of nasal defects]. HNO 2020; 68 (12) 959-970 . German
• 16 Tissiani LAL, Alonso N, Carneiro MH, Bazzi K, Rocco M. Versatilidade do retalho bilobado. Rev Bras Cir Plást 2011; 26 (03) 411-417
• 17 Vasilakis V, Nguyen KT, Klein GM, Brewer BW. Revisiting Nasal Reconstruction after Mohs Surgery: A Simplified Approach Based on the Liberal Application of Local Flaps. Ann Plast Surg 2019; 83 (03) 300-304
• 18 Laitano FF, Teixeira LF, Siqueira EJ, Alvarez GS, Martins PDE, Oliveira MP. Uso de retalho cutâneo para reconstrução nasal após ressecção neoplásica: 102 casos. Rev Bras Cir Plást 2012; 27 (3 Suppl.1): 21
• 19 Redondo P, Bernad I, Moreno E, Ivars M. Elongated Dorsal Nasal Flap to Reconstruct Large Defects of the Nose. Dermatol Surg 2017; 43 (08) 1036-1041
• 20 Marchac D, Toth B. The axial frontonasal flap revisited. Plast Reconstr Surg 1985; 76 (05) 686-694
• 21 Decusati FL, Rinaldi AE. Reconstrução de defeitos nasais utilizando o retalho de Rieger. Rev Bras Cir Plást 2020; 35 (02) 149-153
• 22 Rosseto M, Nunes e. Silva D, Lyrio ALC, Lyrio ALC, Rosseto AC. Retalho nasogeniano de pedículo inferior na reconstrução de asa nasal. Rev Bras Cir Plást 2022; 37 (01) 22-26
• 23 Cerci FB, Nguyen TH. Nasolabial interpolation flap for alar reconstruction after Mohs micrographic surgery. Surg Cosmet Dermatol 2014; 6 (02) 113-120
• 24 Pereira CM, Venturelli Júnior EP, Rocha RS, Gonçalves PR, Silva FN, Bocardo SD. Reconstrução nasal com retalho frontal paramediano após ressecção oncológica. Rev Bras Cir Plást 2020; 35 (03) 373-377
• 25 Zito PM, Hohman MH, Mazzoni T. Paramedian Forehead Flaps [Internet]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; [acesso 2 mar 2022]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK499932/?report=printable
• 26 Beustes-Stefanelli M, O’Toole G, Schertenleib P. The Midlinebased nasolabial transposition (MNT) flap: an original singlestage technique for nasal tip reconstruction. Ann Plast Surg 2015; 74 (04) 426-431
• 27 Sbalchiero JC, Gregório TCR, Leitão L, Leal PRA, Dibe MJA. Condutas na reconstrução da ponta nasal no tratamento das neoplasias cutâneas. Rev Bras Cir Plást 2005; 20 (01) 12-16