Nazal Rekonstrüksiyon
Özet
Nazal rekonstrüksiyon, burun defektlerinin estetik ve fonksiyonel bütünlüğünü koruyarak onarılmasını amaçlayan, anatomi bilgisi ve titiz cerrahi planlama gerektiren karmaşık bir süreçtir. Burnun kaplama (cilt), iskelet (kemik/kıkırdak) ve astar (iç döşeme) olmak üzere üç katmanlı yapısı, altbirim prensiplerine göre değerlendirilmeli ve onarımda defektin boyutu ile hastanın genel sağlık durumu dikkate alınmalıdır. İç döşemenin restorasyonunda ince ve iyi kanlanan ipsilateral veya kontralateral septal mukoperikondriyal flepler gibi intranazal astar fleplerinin yanı sıra, menteşe flepleri, perinazal bölgeden hazırlanan miyomukozal flepler ile geniş kayıplarda radyal önkol serbest flepleri tercih edilmektedir. Yapısal desteğin sağlanması amacıyla otolog septal, aurikuler ve güçlü yapısıyla kostal kıkırdak greftlerinin yanında split kalvarial kemik ve çeşitli alloplastik materyaller (silikon, titanyum vb.) iskelet rekonstrüksiyonunda rol oynar. Cilt kaplama defektlerinin kapatılmasında ise burun alt 1/3 bölgesindeki küçük kusurlar için tam kat cilt greftleri ve bilobe flep kullanılabilirken; daha geniş doku kayıplarında mükemmel renk ve doku uyumu sağlayan paramedian alın flebi ve nazolabial (melolabial) flepler altın standart olarak uygulanmaktadır. Teknolojik gelişmelerle birlikte gelecekte doku mühendisliği ve 3 boyutlu yazıcılarla üretilen biyomateryal iskeletlerin, donör saha morbiditesini azaltarak fasiyal rekonstrüksiyonda geniş yer bulacağı öngörülmektedir.
Nasal reconstruction is a complex process requiring anatomical knowledge and meticulous surgical planning, aiming to repair nasal defects while preserving aesthetic and functional integrity. The three-layered structure of the nose—comprising cover (skin), structure (bone/cartilage), and lining (internal lining)—must be evaluated according to subunit principles, and the repair should consider the defect size along with the patient's general health status. In the restoration of the internal lining, intranasal lining flaps like thin and well-vascularized ipsilateral or contralateral septal mucoperichondrial flaps are preferred, as well as hinge flaps, myomucosal flaps prepared from the perinasal region, and radial forearm free flaps for extensive losses. To provide structural support, autologous septal, auricular, and strong costal cartilage grafts play a role in skeletal reconstruction alongside split calvarial bone and various alloplastic materials (silicone, titanium, etc.). For closing skin cover defects, full-thickness skin grafts and bilobed flaps can be used for small defects in the lower 1/3 of the nose, while the paramedian forehead flap and nasolabial (melolabial) flaps, providing excellent color and texture match, are applied as the gold standard for larger tissue losses. Along with technological advancements, it is anticipated that biomaterial skeletons produced with tissue engineering and 3D printers will find a wide place in facial reconstruction in the future by reducing donor site morbidity.
Referanslar
Patel RG. Nasal anatomy and function. Facial Plastic Surgery. 2017;33(01):003-8.
Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plastic and Reconstructive Surgery. 1985;76(2):239-47.
Menick FJ. Practical details of nasal reconstruction. Plastic and Reconstructive Surgery. 2013;131(4):613e-30e.
Teichgraeber JF, Goepfert H. Rhinectomy: timing and reconstruction. Otolaryngology—Head and Neck Surgery. 1990;102(4):362-9.
Lang PG. The role of Mohs' micrographic surgery in the management of skin cancer and a perspective on the management of the surgical defect. Clinics in Plastic Surgery. 2004;31(1):5-31.
Cannady SB, Cook TA, Wax MK. The total nasal defect and reconstruction. Facial Plastic Surgery Clinics of North America. 2009;17(2):189-201.
Menick FJ. Nasal reconstruction. Plastic and Reconstructive Surgery. 2010;125(4):138e-50e.
Jacobs MA, Christenson LJ, Weaver AL, et al. Clinical outcome of cutaneous flaps versus full‐thickness skin grafts after Mohs surgery on the nose. Dermatologic Surgery. 2010;36(1):23-30.
Sapthavee A, Munaretto N, Toriumi D. Skin grafts vs local flaps for reconstruction of nasal defects: a retrospective cohort study [published online May 28, 2015]. JAMA Facial Plast Surg.
Dibelius GS, Toriumi DM. Reconstruction of cutaneous nasal defects. Facial Plastic Surgery Clinics. 2017;25(3):409-26.
Weathers WM, Bhadkamkar M, Wolfswinkel EM, Thornton JF, editors. Full-thickness skin grafting in nasal reconstruction. Seminars in Plastic Surgery; 2013: Thieme Medical Publishers.
Adams C, Ratner D. Composite and free cartilage grafting. Dermatologic Clinics. 2005;23(1):129-40.
Haack S, Fischer H, Gubisch W. Lining in nasal reconstruction. Facial Plastic Surgery. 2014;30(03):287-99.
Weber SM, Wang TD. Options for internal lining in nasal reconstruction. Facial Plastic Surgery Clinics. 2011;19(1):163-73.
Burget GC, Menick FJ. Nasal support and lining: the marriage of beauty and blood supply. Plastic and Reconstructive Surgery. 1989;84(2):189-202.
Zenga J, Chi JJ. Reconstruction of the intranasal lining. Facial Plastic Surgery. 2017;33(01):067-73.
Cerci FB, Dellatorre G. Paramedian forehead flap combined with hinge flap for nasal tip reconstruction. Anais Brasileiros de Dermatologia. 2016;91:140-3.
Plotner AN, Gloster HM. Combined hinge and nasolabial transposition flap for repair of a full-thickness nasal alar defect. Dermatologic Surgery. 2011;37(3):371-4.
Duffy Jr FJ, Rossi RM, Pribaz JJ. Reconstruction of Wegener's nasal deformity using bilateral facial artery musculomucosal flaps. Plastic and Reconstructive Surgery. 1998;101(5):1330-3.
Pribaz JJ, Meara JG, Wright S, et al. Lip and vermilion reconstruction with the facial artery musculomucosal flap. Plastic and Reconstructive Surgery. 2000;105(3):864-72.
Rahpeyma A, Khajehahmadi S. Facial artery musculomucosal (FAMM) flap for nasal lining in reconstruction of large full thickness lateral nasal defects. Annals of Medicine and Surgery. 2015;4(4):351-4.
Moore EJ, Strome SA, Kasperbauer JL, et al. Vascularized radial forearm free tissue transfer for lining in nasal reconstruction. The Laryngoscope. 2003;113(12):2078-85.
Hahn S. Osseous and cartilaginous nasal reconstruction. Facial Plastic Surgery. 2017;33(01):043-51.
Steiger JD, Bloom J, Becker DG. Auricular cartilage grafts. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2008;19(4):267-72.
Kridel RW, Ashoori F, Liu ES, et al. Long-term use and follow-up of irradiated homologous costal cartilage grafts in the nose. Archives of Facial Plastic Surgery. 2009;11(6):378-94.
Emerick KS, Hadlock TA, Cheney ML. Nasofacial reconstruction with calvarial bone grafts in compromised defects. The Laryngoscope. 2008;118(9):1534-8.
Scopelliti D, Amodeo G. Nasal dorsum reconstruction with alloplastic material. Journal of Craniofacial Surgery. 2016;27(7):e676-e8.
Rodriguez-Prieto MA, Alonso-Alonso T, Sánchez-Sambucety P. Nasal reconstruction with titanium mesh. Dermatologic Surgery. 2009;35(2):282-6.
Phillips TJ. Total nasal reconstruction: a review of the past and present, with a peak into the future. Current Opinion in Otolaryngology & Head and Neck Surgery. 2019;27(5):420-5.
Zitelli JA. The bilobed flap for nasal reconstruction. Archives of Dermatology. 1989;125(7):957-9.
Okland TS, Lee YJ, Sanan A, et al. The bilobe flap for nasal reconstruction. Facial Plastic Surgery. 2020;36(03):276-80.
Gillies H, Millard DR. The Principles and Art of Plastic Surgery: Butterworth; 1957.
Kazanjian V. The repair of nasal defects with the median forehead flap; primary closure of the forehead wound. Surg Gynecol Obstet. 1946;83:37.
Gillies HD. Experiences with tubed pedicle flaps. Surg Gynecol Obstet. 1935;60:291.
Converse JM. Reconstruction of the nose by the scalping flap technique. Surgical Clinics of North America. 1959;39(2):335-65.
Menick FJ. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plastic and Reconstructive Surgery. 2002;109(6):1839-55.
Shokri T, Kadakia S, Saman M, et al. The paramedian forehead flap for nasal reconstruction: from antiquity to present. Journal of Craniofacial Surgery. 2019;30(2):330-3.
Reece EM, Schaverien M, Rohrich RJ. The paramedian forehead flap: a dynamic anatomical vascular study verifying safety and clinical implications. Plastic and Reconstructive Surgery. 2008;121(6):1956-63.
Shumrick KA, Smith TL. The anatomic basis for the design of forehead flaps in nasal reconstruction. Archives of Otolaryngology–Head & Neck Surgery. 1992;118(4):373-9.
Park SS. Reconstruction of nasal defects larger than 1.5 centimeters in diameter. The Laryngoscope. 2000;110(8):1241-50.
Tilt A, Malphrus E, Hannan C, et al. Paramedian Forehead Flap for Reconstruction of Nasal Tip Defect. Plastic and Reconstructive Surgery Global Open. 2020;8(4).
Boyd CM, Baker SR, Fader DJ, et al. The forehead flap for nasal reconstruction. Archives of Dermatology. 2000;136(11):1365-70.
Kouby F, Chanal J, Jafari A, et al. Le lambeau de Rieger-Marchac: complications et satisfaction des patients. Annales de Dermatologie et de Vénéréologie; 2020: Elsevier.
Zavod MB, Zavod MB, Goldman GD. The dorsal nasal flap. Dermatologic Clinics. 2005;23(1):73-85.
Barton Jr FE, Gyimesi IM. Anatomy of the nasolabial fold. Plastic and Reconstructive Surgery. 1997;100(5):1276-80.
Yellin SA, Nugent A. Melolabial flaps for nasal reconstruction. Facial Plastic Surgery Clinics. 2011;19(1):123-39.
Larrabee WF, Makielski KH, Henderson JL. Surgical anatomy of the face: Lippincott Williams & Wilkins; 2004.
Griffin GR, Chepeha DB, Moyer JS. Interpolated subcutaneous fat pedicle melolabial flap for large nasal lining defects. The Laryngoscope. 2013;123(2):356-9.
Salibian AH, Menick FJ, Talley J. Microvascular reconstruction of the nose with the radial forearm flap: A 17-year experience in 47 patients. Plastic and Reconstructive Surgery. 2019;144(1):199-210.
Hollister SJ. Porous scaffold design for tissue engineering. Nature Materials. 2005;4(7):518-24.
Shieh S-J, Terada S, Vacanti JP. Tissue engineering auricular reconstruction: in vitro and in vivo studies. Biomaterials. 2004;25(9):1545-57.
Partee B, Hollister SJ, Das S. Selective laser sintering process optimization for layered manufacturing of CAPA® 6501 polycaprolactone bone tissue engineering scaffolds. 2006.
Zhou G, Jiang H, et al. In vitro regeneration of patient-specific ear-shaped cartilage and its first clinical application for auricular reconstruction. EBioMedicine. 2018;28:287-302.
VanKoevering KK, Zopf DA, Hollister SJ. Tissue engineering and 3-dimensional modeling for facial reconstruction. Facial Plastic Surgery Clinics. 2019;27(1):151-61.
Zopf DA, Mitsak AG, Flanagan CL, et al. Computer aided–designed, 3-dimensionally printed porous tissue bioscaffolds for craniofacial soft tissue reconstruction. Otolaryngology--Head and Neck Surgery. 2015;152(1):57-62.
