Early reconstruction Nasal

Although cartilage, bone, and mucous membrane lining often are missing in major defects, the most obvious tissue deficiency is skin. Sushruta Samita described the reconstruction of the nose with cheek flaps in 600 BC. The origins of forehead rhinoplasty (Indian method) are obscure but it had been performed in India by the Kanghiara family since 1440 AD and probably long before the birth of Christ. The operation was undertaken by members of a cast of potters known as the Koomas.

In Europe during the 15th century, the Branca family practiced the Indian method of rhinoplasty. Sicily was the center of Arabian, Greek, and Occidental learning at the time, which made knowledge of translations of the Indian operation accessible. Tagiacozzi refined the technique of arm rhinoplasty (Italian method) in the late 16th century. However, the 17th and 18th centuries were a dark period for surgery, particularly plastic surgery. Tales of slaves donating their buttocks to provide tissue for their owner's noses were ridiculed. It was said that a mystic sympathy existed between the new nose and the person from whom it was taken; when the donor died, so did the new nose. Yet, when the first written account in English of the Indian midline forehead flap rhinoplasty appeared in the Madras Gazette in 1793, the mood was more receptive.

One year later, the article was reproduced in Gentleman's Magazine of London. It stirred the imagination of European surgeons immediately, and Carpue, an English surgeon, published his account of two successful operations in 1816. By 1897, at least 152 rhinoplasties had been performed in Europe. These earliest operations were performed almost exclusively with a median forehead flap.

This classic Indian rhinoplasty, popularized in America by Kazanjian in 1946, used a vertical flap from the mid line of the forehead. The flap received its blood supply from paired supratrochlear vessels. Incisions extended from the hairline to a point immediately above the nasofrontal angle and penetrated to the periosteum. At the junction of the forehead and root of the nose, the lower portion of the flap was elevated by blunt dissection to protect its paired feeding vessels. The base of the flap twisted 180°, with its arc of rotation at or above the eyebrows. The forehead donor sites in these early operations were allowed to heal by secondary intention.