Nasal Reconstruction—The Challenge “Par Excellence” for Plastic Surgery

Helmut Fischer, MD

Once and again nasal reconstruction is in the spotlight of the reconstructive community. I am focusing on that since more than 20 years and the fascination emerging from reconstructive surgery on the nose is still growing. That experience is in coincidence with the same in rhinoplasty. You cannot imagine a point where you feel you have made it. As in so many other fields, each solution creates 10 new questions and you can hardly wait until you get a new case to make it better—more natural a nose, better airway dimensions, thinner alar wings, well-defined alar creases, smaller tip, less stiffness, less surgical load for the patient, and so on.

Our team presents our present experience in searching for the “golden reconstruction” in several articles and I feel honored by all further contributions highlighting specific technical procedures and the result of greatest experience.

Embedding our efforts in the historical background is important to gain a true level for what we are doing. Tumor therapy has to be based on reliable clearance of the malignancy as a prerequisite for complex surgical procedures that cannot easily be repeated in case of tumor recurrence. So, the three-dimensional histology concept we adapted ourselves years ago is a real improvement, although a little more effort for the surgeon.

For minor defects, we swing back and forth from local flaps to grafts and vice versa. Either technique has its pros and cons and primary and tertiary indications. Only growing experience helps to get good results in these so-called minor challenging cases yet representing the majority of patients. They will come asking for revision if the final result is disfiguring or continue to search for help elsewhere—a major fact.

Perforator flap techniques represent real progress and can improve esthetic results or reduce the treatment load for the patient or both. Continuous effort will bring forward what is feasible based on microanatomy and vascular architecture. I am sure that this input will encourage additional efforts, ideas, and solutions.

Nasal reconstruction in children and in congenital deformities is a special challenge as experience is limited. Which concepts stand the test of time? The problems are comparable with the experiences in the field of cleft lip and palate surgery.

I hope all the articles dealing with total nasal reconstruction help those who face this most demanding surgery to avoid the mistakes and failures that are the stimulation and real background for success, supreme experience, and outstanding result.

I want to thank especially Frederick Menick, my great mentor, and Joachim Quetz for inspiring discussions day and night and Wolfgang Gubisch committing this task area into my hands within our department.

Last but not least, I want to thank all the authors for taking that huge additional work load for preparing the articles and contributing to an issue worth a privileged space in the reader's library.