Total reconstruction of the nose after severe injury

Facial injury is not a very common cause of nasal defect. Even in the severest injury, the nasal component may well be preserved through a tiny pedicle. In the case of flame or chemical burns on the face, however, secondary nasal reconstruction may be required. In such cases, local facial skin is not available for resurfacing the nose. Therefore, nasal reconstruction should be considered as a part of the staged surgery for total face reconstruction. Whatever the cause of the nasal defect, three layers are required to reconstruct the whole nose: the mucosa, supportive tissue and skin. In case of severe injury, local skin may be recruited to reconstruct the nasal lining. Therefore, usually the skin and a bone composite flap may be necessary. The radial forearm osteocutaneous flap is the preferred choice for such cases. An example of total nose reconstruction after a severe traffic accident using a free radial forearm osteocutaneous flap is presented.