Psychosocial dysfunction during nasal reconstruction
Reviewed by Felipe Culaciati

Reconstructive surgery following skin cancer malignancy creates important levels of psychosocial distress, especially if it is located in an important aesthetic zone of the face like the nose. The authors present their findings of a prospective study group of patients who underwent nasal reconstruction due to prior skin cancer malignancy. The main outcome of this study is the amount of psychosocial distress associated with nasal reconstruction. This variable was measured using the Derriford Appearance Scale 24. The authors also compared the levels of distress with the type of surgical technique used for nasal reconstruction. The Derriford Appearance Scale was administered to the patients preoperatively, between the first and fourth week, between the first and third month and after three months post surgery. The type of reconstruction was categorised as interpolated flaps, local tissue flaps and full-thickness skin graft. Fifty-nine patients were included in this study, among the surgical techniques used for reconstruction, 14 interpolated flaps, 17 local tissue flaps and 28 full-thickness skin grafts were performed. The authors found that higher levels of distress appeared in patients during early postoperative consults but with a clear tendency to decrease during the subsequent controls. Among the surgical techniques applied, the interpolated flap group presented important levels of distress in comparison with the full-thickness skin graft group, during late follow-up controls both groups presented similar levels of distress. Conclusions: despite the fact that skin cancer defects can be quite significant initially, the most important levels of distress occur with the use of the interpolated flap and during early postoperative controls. Evolution in time is a positive factor to reduce distress; the interpolated flap group reached similar levels of distress as the full-thickness skin graft group during later postoperative controls. Quality of life is a key factor to measure as an outcome in facial plastic and reconstructive surgery, especially in patients who are candidates for reconstruction prior to skin cancer surgery. Psychosocial distress clearly represents quality of life, this article is a clear effort to produce a reliable assessment tool to measure this important outcome variable. 

Patient assessment for psychosocial dysfunction following nasal reconstruction.
Pepper JP, Asaria J, Kim JC, et al.
PLASTIC AND RECONSTRUCTIVE SURGERY
2013;129(2):430-7.