Nasal defects are a
difficult problem and nasal reconstruction should be accomplished
while maintaining adequate nasal function.
The midline forehead
flap or the "Indian" flap provides the principal and fundamental
technique for nasal reconstruction even today.
began sometime around 2000 B.C. in India because Indian culture
then, believed in punishment of adultery by amputation of the nasal
tip. Around 600 B.C. Sushruta Samhita documented the first facial
flap for reconstruction of the nose, through the use of the midline
forehead flap, or "Indian" flap.
The best donor site
for nasal defects is the forehead. It is an excellent match for
color and texture, reliable blood supply and minimal donor site
deformity. The disadvantage is that it leaves a forehead scar and
the length is limited.
One must consider what
the patient desires. When the goal becomes reconstruction of an
aesthetically appealing nose, it should be thought of as three-dimensional.
The nose is composed
of a vascular lining, support structures and a covering. The structural
support and the vascular lining are interdependent. The lining depends
on the cartilage for support and the cartilage depends on the lining
for its vascular supply. Nasal lining is best reconstructed from
intranasal donor sites.
The blood supply for
the intranasal lining flaps can arise from several sources with
the main source being the septal branch of the superior labial artery.
Replacement of nasal lining can impair nasal function if not done
correctly. Usually this is seen when tissues such as skin grafts,
local nasal skin and composite auricular grafts are used for lining.