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Assessing Aesthetic Outcomes Following Nasal Reconstruction
Jesse E. Menville, Margaret R. Wang
*, Nidhi Shinde, Fiona Griffin, Amy Kite, Albert S. Woo
Division of Plastic and Reconstructive Surgery, Brown University, Providence, RI
Purpose: This study compares aesthetic outcomes of different nasal reconstruction techniques following Mohs micrographic surgery.
Methods: A retrospective review was conducted on patients who underwent primary nasal reconstruction by the senior author over an eight-year period. Data collected included patient demographics, reconstruction method, defect size, revision procedures, smoking status, postoperative photos, and follow-up duration. Patients were categorized into five groups: forehead skin grafts [
Group 1], other skin grafts (ear or neck) [
Group 2], cheek flaps (nasolabial or cheek advancement flaps) [
Group 3], paramedian forehead flaps [Group 4], and local skin flaps (including banner, bilobed, and dorsal nasal flaps) [
Group 5]. Aesthetic outcomes were assessed by a blinded plastic surgeon using a 1-5 Likert scale. Ordinal logistic regression models were used to assess the adjusted effects of age, sex, defect size, and smoking status on Likert rating.
Results: 173 cases met inclusion criteria. Average patient age was 65.3 years. Distribution included 11 patients in
Group 1, 39 in
Group 2, 19 in
Group 3, 35 in
Group 4, and 69 in
Group 5. Intra-rater reliability was significant (Kappa = 0.8). Analysis revealed that reconstructions using local skin flaps (Group 5) were significantly more likely to be rated favorably compared to those using neck or ear grafts (Group 2) (OR=0.43, CI=[0.19-0.92],
p=0.032). Former smoking status negatively affected outcomes (OR=0.44, CI=[0.22-0.85],
p=0.017), while age and sex were not significant predictors.
Conclusion: Local skin flaps provided the most favorable aesthetic outcomes for nasal ala reconstruction.
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