02400nas a2200337   4500000000100000008004100001260001600042653001000058653002500068653001400093653001400107653001100121653002200132653001100154653001200165653000900177653001600186653001000202653003100212653003200243653002600275653001600301653001900317100001400336700001600350245006000366300002900426490000800455520158500463022001402048       2004                            d  c2004 Sep 1510aAdult10aBone Transplantation10aCartilage10aEsthetics10aFemale10aFollow-Up Studies10aHumans10aleprosy10aMale10aMiddle Aged10aNepal10aNose Deformities, Acquired10aPostoperative Complications10aRetrospective Studies10aRhinoplasty10aSurgical Flaps1 aSchwarz R1 aMacdonald M00aA rational approach to nasal reconstruction in leprosy.  a876-82; discussion 883-40 v1143 a<p>Destruction of the nasal septum and nasal bones by Mycobacterium leprae and subsequent infection is still seen regularly in leprosy endemic areas. The social stigma associated with this deformity is significant. Many different procedures have been developed to reconstruct the nose. Patients operated on at Anandaban Hospital and the Green Pastures Hospital and Rehabilitation Center between 1986 and 2001 were reviewed. There were 48 patients with an average age of 47 years. Five deformities were mild, 22 were moderate, 13 were severe, and eight were not graded. Bone grafting with nasolabial skin flaps was performed in 14 cases, bone grafting alone was performed in 10 cases, flaps alone were performed in seven cases, and cartilage grafting was performed in 10 cases. In three patients, a prosthesis was inserted, and in three patients a gull-wing forehead flap was performed. Overall, excellent or good cosmetic results were obtained in 83 percent of cases. Grafting with conchal cartilage was associated with the best cosmetic results and had minimal complications. Bone grafting with or without nasolabial flaps was associated with a 50 percent complication rate of infection or graft resorption. In mild to moderate deformities, cartilage grafting is recommended; for more severe deformities, bone grafting with bony fixation and skin flaps is recommended. Perioperative antibiotics must be used, and these procedures should be performed by an experienced surgeon. In very severe cases with skin deficiency, reconstruction with a forehead flap gives good results.</p>  a0032-1052