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Replantation of the Amputated Nose
Philip J. Miller, MD;
Craig Hertler, MD;
George Alexiades, MD;
Ted A. Cook, MD
Arch Otolaryngol Head Neck Surg. 1998;124:907-910.
Objective To assess the effectiveness of replantation in the treatment of nasal amputations.
Design Retrospective chart review.
Setting A university medical center.
Results In no case did the replant survive completely, and in all cases revision surgery was required. However, in all cases, the resulting deformity was less than the original defect. In our pediatric patients, reconstruction with cartilage grafting and a midline forehead flap was successful and demonstrated proportionate and appropriate growth.
Conclusions It is our belief that replantation serves many therapeutic functions. At the very least, there is the psychological/emotional factor that is involved in attempting to replace a native body part that has been severed. Also, it is difficult to persuade parents and patients that the amputated tissue that has been handled with kid gloves by paramedics, maintaining its pink "alive" color, is ultimately doomed to failure. Forehead flaps and conchal cartilage grafts are more willingly accepted after a "failed" replantation than as primary reconstructions. In every instance, we believe, the ultimate defect will be smaller than the original deformity. Certainly, the need for vestibular lining reconstruction is far less. Thus, the ultimate healed defect from the replantation greatly facilitates final nasal reconstruction.
From the Divisions of Facial Plastic and Reconstructive Surgery, Departments of Otolaryngology, New York University School of Medicine, New York, NY (Drs Miller and Alexiades); and Oregon Health Science University, Portland (Dr Cook). Dr Hertler is in private practice, Portland, Ore.
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