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- Presentation
Three-Dimensional Reconstruction of Complex Nasal and Lip Defects
Description
The speaker discussed three-dimensional reconstruction of complex nasal and lip defects, emphasizing that tissue repair is not simply “filling a hole” but restoring structure, contour, lining, support, and function. For a smaller nasal tip and alar full-thickness defect, the recommended approach included cartilage support and a paramedian forehead flap, with attention to hidden seams and curved contour for a natural result. For a much more extensive near-total nasal defect involving the tip, ala, dorsum, columella, and upper lip, the speaker described a staged reconstruction using rib cartilage supplied by a colleague, septal and hinge flaps for lining, cartilage grafting, and a multistage forehead flap, followed by thinning and revision to restore projection, breathing, and appearance. For a full-thickness upper lip defect with muscle loss, the discussion focused on preserving oral competence, speech, eating, and symmetry; options included avoiding overly large wedge resections to prevent microstomia and using modified rotational/advancement techniques such as a Carapanzic-style flap to maintain function. Across the examples, the speaker highlighted staged planning, structural grafting, and careful flap design to achieve both functional and aesthetic success.
View moreConclusions
- Successful reconstruction of complex nasal and lip defects depends on treating them as three-dimensional structural problems rather than simple skin closures.
- For full-thickness nasal defects, durable outcomes require a combination of lining, cartilage framework, and external skin coverage, often using staged reconstruction.
- A paramedian forehead flap can provide reliable nasal skin coverage and, when thinned and staged appropriately, can restore contour and tip projection.
- Septal, hinge, and other internal flaps can effectively reconstruct nasal lining, but they must be matched with structural cartilage support to avoid a floppy result.
- Larger and more complete nasal losses may require multi-pronged reconstructions that combine septal flaps, cartilage grafts, and forehead flaps to restore both form and breathing.
- Preserving or recreating nasal function, especially airway patency, is as important as achieving an acceptable cosmetic result in major nasal reconstruction.
- For large lower-lip defects, maintaining oral competence and speech function is critical, so reconstruction must account for muscle involvement, not just skin coverage.
- When the orbicularis muscle is preserved, up to about 40 to 50 percent of the lip may be reconstructed relatively simply with local tissue movement.
- When the lower lip defect is central and functionally complex, a Karapandzic-type advancement/rotation flap can restore symmetry while preserving motor and vascular supply.
- The presented cases suggest that carefully selected staged local flap techniques can achieve good long-term functional and aesthetic outcomes even in very large facial defects.
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