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Kevin A. Shumrick, MD; Andrew Campbell, MD; Ferdinand F. Becker, MD; Ira D. Papel, MD

Arch Facial Plast Surg. 1999;1:9-15.

This article reports our observations on, and modification of, the subunit principle with regard to reconstruction of nasal tip and dorsum defects. Forty-two patients who underwent reconstruction of a nasal tip and/or dorsum defect with a forehead flap were reviewed. These patients were categorized by how the subunit principle was used in their reconstruction and graded on the aesthetic outcome of the reconstruction. We found that the patients who had both the nasal tip and dorsum replaced obtained better results than those who had just 1 subunit replaced (P=.008). Review of postoperative photographs shows that the reason for this discrepancy in aesthetic outcomes is the line of transition between the forehead skin and remaining nasal skin if only 1 subunit is replaced. With this observation in mind, we feel that patients undergoing reconstruction of the nasal tip and/or dorsum should be evaluated for discrepancies in tissue type between the recipient nasal site and forehead donor site. If the tissues are noted to be significantly disparate, the reconstructive surgeon may consider replacing both subunits with a single forehead flap.

From the Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati, Ohio (Drs Shumrick and Campbell); Facial Plastic Surgical Center Inc, Vero Beach, Fla (Dr Becker); and Facial Plastic Surgicenter Ltd, Owing Mills, Md (Dr Papel).

RELATED LETTER

Modification of the Subunit Principle
Kevin A. Shumrick, Andrew Campbell, Ferdinand F. Becker, and Ira D. Papel
Arch Facial Plast Surg. 1999;1(2):136-137.
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Modification of the Subunit Principle
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Arch Facial Plast Surg. 1999;1(1):16-18.
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Modification of the Subunit Principle
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Arch Facial Plast Surg 1999;1:136-137.
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