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REPAIR OPTIONS: NASAL DORSUM
Preferred options when standard side-to-side closure is not possible
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Smaller defects on the dorsum of the nose can easily be closed with a side-to-side closure due to the skin laxity in this area.1 The skin on the dorsum is not as sebaceous as the nasal tip and ala, and skin from the adjacent cheek and glabella provide a good tissue match as donor sites for flaps.
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Specific issues of concern when closing defects on the dorsum of the nose include nasal tip elevation, blunting of the angle of the nasal root concavity, and accentuating any convexity of the nasal dorsum.
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Wide undermining required
Risk of blunting at the nasal root concavity
Risk of accentuation of the dorsal convexity
Long unbroken line may be more obvious, especially if scar troughing occurs
Edge necrosis common, especially if wound under tension or rhinophymatous nasal skin
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For midline defects, a vertically oriented ellipse is the design most frequently used (see Fig. 3.1). However, if there is a prominent dorsal convexity or nasal tip ptosis, a horizontal orientation may be better (see Fig. 3.2). Further, curvilinear closure may be a better aesthetic option for paramedian defects—curving the upper scar into the oblique skin creases or relaxed skin tension lines more proximally (see Fig. 3.3) or curving the lower pole into the alar crease to avoid crossing into the sebaceous lobule (see Fig. 3.4). Partial side-to-side closure with a Burow’s full-thickness skin graft (see Fig. 3.5) reduces central defect tension.2
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Outline the vertical ellipse (generally greater than the usual 3:1 ratio is required) and anaesthetise the area including the lateral nasal sidewalls, nasal root and nasal tip.
Undermine widely, often better in submuscular plane and even up to the nasofacial sulcus, if needed to attain necessary movement.
After using skin hooks to ensure the advancing wound edges easily approximate, excise standing cones of redundancy at superior and inferior ...