[Nasal reconstruction with reference to the nose in leprosy].

For the reconstruction of the nostril a nasolabial flap is recommended. According to the method of Pers (1967), the upper part of the flap is used for lining and the lower part for the outside coverage of the defect. In order to avoid lateral traction on the nostril, the author recommends that a small triangular flap with an inferior pedicle is left between the nasolabial flap and the nostril. For total reconstruction of the nose, a frontal flap with a primary cantilever bone graft as described by Millard (1966) is suggested. We advise to take one half of forehead skin. This gives a less obvious donor site and enough length in the diagonal direction for the dorsum of the nose and the columella. For the leprotic nose it is emphasized that no skin loss is present, there is only a loss of lining and support. In all advanced cases a large septal defect is encountered. The reliable postnasal inlay of Gillies is mentioned but the draw back to this method is that the care of the postnasal prosthesis may be difficult for leprosy patients with disabled hands. Secondary bone grafting after this procedure has a high failure rate because of infection. For these reasons the reconstruction of lining by two nasolabial flaps according to Farina (1957) is described. The author has regularly used this method with a primary cantilever graft. A modification is again suggested. A small triangular skin flap is raised with the ala, thus avoiding lateral traction on the nostrils after closure of the donor site.