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Former nasal reconstruction techniques were limited to skin coverage and to the middle part of the nasal framework. Unfortunately, the results were not stable in time, secondary distortions and scarring of the reconstructed nose occurred. Modern techniques are based on the complex reconstruction of all the nose layers, especially the reconstruction of the inner mucosal lining, where the septal flaps are commonly used. Supporting layer of the nose is completely reconstructed using the cartilage or even the bone graft is applied in the dorsal part. Local flaps are used for nasal surface reconstruction because of their vascularity, color and texture. The paramedian forehead flap in its three-stage modification is considered as an ideal solution for larger nose defects. In case the defect impacts more than 50% of the size of the aesthetic nasal subunit, the entire subunit is replaced. Although the overall length of the reconstruction is longer and the number of necessary treatments has increased, the good aesthetic and functional result of a nose reconstruction, that are stable over time, are achieved when above mentioned principles are followed. [ABSTRACT FROM AUTHOR]

Abstract: Clinical results of functional reinnervation after application of autogeneous nerve grafts obtained from cutaneous nerves have not always been satisfactory. A foreign extracellular condition especially for regeneration of motor axons is assumed to be one of the reasons explaining these unsuccessful results. The role of endoneurial extracellular matrix in regeneration and maturation of motor axons was studied using acellular nerve segment prepared from muscular or cutaneous nerves applied between stumps of transected motor branch of the femoral nerve. No differences were found in the numbers of regenerated axons and related motoneurons through the motor and cutaneous nerve grafts 1 month after operation. Two months from grafting, however, the numbers of motoneurons and regenerated axons were increased significantly in the motor grafts while these were decreased after regeneration through the cutaneous grafts compared with 1 month. Axons’ diameter and thickness of their myelin sheaths were similar in the cutaneous grafts 1 and 2 months after grafting. In comparison to 1 month, axons had larger diameter and thicker myelin in the motor than cutaneous nerve grafts 2 months from their application. Results of morphometric analysis indicate more beneficial extracellular conditions for regeneration and maturation of myelinated motor nerve axons in the acellular motor than cutaneous nerve graft. Generally, the results revealed that the endoneurial extracellular matrix of motor fibers has a positive effect on regeneration and maturation of motor nerve axons after lesion. [Copyright &y& Elsevier]