- Email: [email protected]
Reconstruction of columella
RECONSTRUCTION OF C O L U M E L L A By ERNESTO F. MALBEC,M.D., and ALBERTOR. BEAUX,M.D.
Hospital Ramos Mefia, Buenos Aires MANY techniques for reconstruction of the columella, using tissues from the lip, nose, ear, cheek, or forehead, or from distant sites, have been proposed. Having reviewed them all exhaustively in our report of 195o, we shall refer here solely to a procedure we have used in seven cases with such satisfactory results that we consider it to be the best. This is reconstruction of the columella by the Gillies-Filatow tubular graft taken either from the inner aspect of the upper arm or from the cheek. In women, a tube is taken from the inner plane of the arm to avoid additional facial scarring and to obtain soft elastic skin devoid of hair (Fig. I). In men we prefer the cheek, preferably at the level of the fold or crease running from the nose to the mouth angle where the thickness of the skin and its elasticity help to form a thin tube (Fig. 2). T e c h n i q u e . - - T h i s is simple and easy in execution. A thin tube is formed, long enough to be taken to the new site of implantation without tension, and not too thick nor too thin to give adequate nutrition and so compromise its vitality. Once vitality is ensured, the lower end of the tube is divided and transferred to the base of the nose. This intermediate stage ensures the vitality of the graft by avoiding primary fixation to the fibrotic nasal defect. Generally, three weeks after this step, the fixed end of the tube is divided and after making it the same length as the lost tissue, the free end is fixed to the nasal defect. In cases where the nasal septum survives destruction of the columella, at the time of joining the tube to the nasal defect we split and dissect away on both sides of this cartilagenous septum enough mucosa to form flaps that may be sutured to the under side of the skin of the tube. No dressings or bandages are used. We prefer to leave the sutures exposed, covered only with an ointment containing some antibiotic. When an arm flap is used in women, the arm is fixed in the correct position to the head by a plaster cast, but it is most important that the hand be given enough support and that provision be made for finger exercises. I f the hand is allowed to hang down, a dropped wrist may result, which will take much time and work to correct. Although this position with the arm braced and fixed against the head is rather awkward and seemingly uncomforable, we have as yet not found it necessary to remove any cast, although the patients are women some of whom are very nervous, or young children who are easily frightened. Columellas thus obtained are very fleshy, well-rounded, resistant, and with all the surfaces covered with elastic skin of a good colour and quality as will be seen in the accompanying photographs of some of our patients (Figs. 3 to 7). I42
RECONSTRUCTION
OF
COLUMELLA
FIGS. I a n d 2 Fig. I . - - M e t h o d o f reconstruction o f columeUa in w o m e n . Fig. 2 . - - M e t h o d of reconstruction o f columena in m e n .
143
~I44
BRITISH
JOURNAL
OF
PLASTIC
Fins. 3 and 4 Results.
SURGERY
RECONSTRUCTION
OF
FIGS. 5 to 7 Results.
COLUMELLA
I45:
146
BRITISH
JOURNAL
OF PLASTIC
SURGERY
SUMMARY
Reconstruction of the columella, using a Gillies-Filatow tube taken from the cheek or the inner aspect of the forearm, has been carried out in several patients. This procedure of easy execution gives a satisfactory result. REFERENCE MALBEC, E. F., and BEAUX,A. R. (I95o). VII Congreso Internac. de Cirugla, Buenos Aires.
Hospital Ramos Mefia, Buenos Aires MANY techniques for reconstruction of the columella, using tissues from the lip, nose, ear, cheek, or forehead, or from distant sites, have been proposed. Having reviewed them all exhaustively in our report of 195o, we shall refer here solely to a procedure we have used in seven cases with such satisfactory results that we consider it to be the best. This is reconstruction of the columella by the Gillies-Filatow tubular graft taken either from the inner aspect of the upper arm or from the cheek. In women, a tube is taken from the inner plane of the arm to avoid additional facial scarring and to obtain soft elastic skin devoid of hair (Fig. I). In men we prefer the cheek, preferably at the level of the fold or crease running from the nose to the mouth angle where the thickness of the skin and its elasticity help to form a thin tube (Fig. 2). T e c h n i q u e . - - T h i s is simple and easy in execution. A thin tube is formed, long enough to be taken to the new site of implantation without tension, and not too thick nor too thin to give adequate nutrition and so compromise its vitality. Once vitality is ensured, the lower end of the tube is divided and transferred to the base of the nose. This intermediate stage ensures the vitality of the graft by avoiding primary fixation to the fibrotic nasal defect. Generally, three weeks after this step, the fixed end of the tube is divided and after making it the same length as the lost tissue, the free end is fixed to the nasal defect. In cases where the nasal septum survives destruction of the columella, at the time of joining the tube to the nasal defect we split and dissect away on both sides of this cartilagenous septum enough mucosa to form flaps that may be sutured to the under side of the skin of the tube. No dressings or bandages are used. We prefer to leave the sutures exposed, covered only with an ointment containing some antibiotic. When an arm flap is used in women, the arm is fixed in the correct position to the head by a plaster cast, but it is most important that the hand be given enough support and that provision be made for finger exercises. I f the hand is allowed to hang down, a dropped wrist may result, which will take much time and work to correct. Although this position with the arm braced and fixed against the head is rather awkward and seemingly uncomforable, we have as yet not found it necessary to remove any cast, although the patients are women some of whom are very nervous, or young children who are easily frightened. Columellas thus obtained are very fleshy, well-rounded, resistant, and with all the surfaces covered with elastic skin of a good colour and quality as will be seen in the accompanying photographs of some of our patients (Figs. 3 to 7). I42
RECONSTRUCTION
OF
COLUMELLA
FIGS. I a n d 2 Fig. I . - - M e t h o d o f reconstruction o f columeUa in w o m e n . Fig. 2 . - - M e t h o d of reconstruction o f columena in m e n .
143
~I44
BRITISH
JOURNAL
OF
PLASTIC
Fins. 3 and 4 Results.
SURGERY
RECONSTRUCTION
OF
FIGS. 5 to 7 Results.
COLUMELLA
I45:
146
BRITISH
JOURNAL
OF PLASTIC
SURGERY
SUMMARY
Reconstruction of the columella, using a Gillies-Filatow tube taken from the cheek or the inner aspect of the forearm, has been carried out in several patients. This procedure of easy execution gives a satisfactory result. REFERENCE MALBEC, E. F., and BEAUX,A. R. (I95o). VII Congreso Internac. de Cirugla, Buenos Aires.