Abstract
Numerous reconstructive techniques for nasal defects following skin cancer removal have been described; however, the literature lacks a comprehensive systematic review. Our objective was to systematically review nasal reconstruction methods after tumor removal, correlate the use of specific techniques to the nasal subunits involved, assess the quality of the available evidence, and set the stage for future research on this topic. Eight databases were searched for studies published in English from January 2004 to December 2018 containing repair data for nasal defects following Mohs or excision for four or more subjects. Recorded data included author specialties, study design, subject number, demographics, defect characteristics, procedure type, reconstructive methods, outcome measures, and complications. One-hundred and eleven studies were included. Study types included case series (73%), observational cohort studies (25%), and clinical trials (2%). Most authors were dermatologic surgeons (61%). Resection was most commonly performed via Mohs (82%). Flaps (42%), linear closures (28%) and grafts (25%) were most utilized for reconstruction. In Zones I and II, transposition flaps were the most common followed by advancement flaps. In Zone III, full thickness skin grafts were the most common repair. Most studies were case series or small cohort studies, representing low level evidence. Flaps are the most common method described in the literature for nasal reconstruction. The overall quality of the evidence available on this topic is low.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References:
Austin GK, Shockley WW (2016) Reconstruction of nasal defects: contemporary approaches. Curr Opin Otolaryngol Head Neck Surg 24:453–460
Burget GC, Menick FJ (1985) The subunit principle in nasal reconstruction. Plast Reconstr Surg 76:239–247
Costin A, António AM, Goulão J (2019) Perialar semilunar advancement flap for the reconstruction of nasal sidewall defects: our experience. J Cutan Aesthet Surg 12:71–73
Egeler SA, Johnson AR, Ibrahim AMS, Bucknor A et al (2019) Reconstruction of Mohs defects located in the head and neck. J Craniofac Surg 30:412–417
EndNote [computer program]. Version X.7. Philadelphia, PA: Clarviate.
Kelly-Sell M, Hollmig ST, Cook J (2018) The superiorly based bilobed flap for nasal reconstruction. J Am Acad Dermatol 78:370–376
Leibovitch I, Huilgol SC, Selva D, Richards S et al (2005) Basal cell carcinoma treated with Mohs surgery in Australia I. Experience over 10 years. J Am Acad Dermatol 53:445–451
Lu GN, Kriet JD, Humphrey CD (2017) Local cutaneous flaps in nasal reconstruction. Facial Plast Surg 33:27–33
Mahlberg MJ, Leach BC, Cook J (2012) The spiral flap for nasal alar reconstruction: our experience with 63 patients. Dermatol Surg 38:373–380
Mosterd K, Krekels GA, Nieman FH, Ostertag JU et al (2008) Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol 9:1149–1156
Mori WS, Demer AM, Mattox AR, Maher IA (2019) Mohs micrographic surgery at challenging anatomical sites. Dermatol Surg 45(Suppl 2):S142–S154
OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. Available from: http://www.cebm.net/index.aspx?o55653. Accessed Apr 2021
Rayyan [computer program]. Doha, Qatar: Qatar Computing Research Institute.
Rogers HW, Weinstock MA, Feldman SR, Coldiron BM (2015) Incidence estimate of nonmelanoma skin cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012. JAMA Dermatol 151:1081–1086
Shahwan K, Mattox A, Maher I, Alam M, et al. Systematic review of repair methods on the nose following Mohs surgery or surgical excisions. PROSPERO 2019 CRD42019119315 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019119315. Accessed Apr 2021
Spataro E, Branham GH (2017) Principles of Nasal Reconstruction. Facial Plast Surg 33:9–16
Wang Z-G, Chen X-J, Chen Z-Y (2014) A modified bilobed flap design for nasal tip defects. Plast Aesth Res 1:16–20
Funding
No funding was obtained to help complete this work.
Author information
Authors and Affiliations
Contributions
The authors confirm contribution to the paper as follows: study conception and design: KTS, ARM, MA, IAM; data collection: KTS, LAK, RSK; analysis and interpretation of results: MJV, KTS, LAK, ARM, MA, IAM. Author; draft manuscript preparation: MJV, KTS, LAK. All authors reviewed the results and approved the final version of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose.
Ethics approval
This study is a systematic review and therefore no ethical approval is required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Visconti, M.J., Archibald, L.K., Shahwan, K.T. et al. Nasal reconstructive techniques following Mohs surgery or excisions: a systematic review. Arch Dermatol Res 315, 333–337 (2023). https://doi.org/10.1007/s00403-022-02390-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-022-02390-8