Management of composite defects of the nose, cheek, eyelids and upper lip

AIM: To assess the results of reconstruction of composite defects involving the nose which extend to involve the cheeks, eyelids or upper lip. STUDY DESIGN: Retrospective observational study. MATERIAL: Sixteen patients with defects of the nose extending to the adjoining cheek, upper lip or eyelid. METHOD: A combination of flaps and grafts were needed to reconstruct these defects so that the aesthetic subunits were replaced and joined at their junctions wherever possible. RESULTS: Where the defect required three or four flaps, there was some unpredictable cicatrisation at their junction that resulted in some asymmetry. This problem primarily occurred at the alar base, and was compounded if there was tissue loss of the premaxilla or maxilla. CONCLUSION: If a defect that involves the nose, cheek and upper lip is repaired with a combination of cheek advancement, nasolabial, paramedian forehead and/or septal flaps, there can be unpredictable cicatrisation at their junction, particularly at the alar base. In these circumstances, we recommend replacing the nasal and other defects with a slightly more generous amount of tissue than would be taken to repair a similar, but solitary, defect. It is important to replace any loss of the facial skeleton, in order to provide support for overlying flaps.