An illustrative presentation of the procedure which lasted several months. Foto: UKC Ljubljana
An illustrative presentation of the procedure which lasted several months. Foto: UKC Ljubljana

The nose was reconstructed on the forearm using a 3D model, following which the nose was placed on the face. 'You get a nose from your forearm. As if it would flow out from you, or as if you were born anew. If necessary, I would go through it all again,' said the happy patient after the operation.

The basic idea was to make a nose from bones and soft tissues on the forearm, leave it there for a month and then, in the second stage, place it on the patient’s face, explained Uroš Ahčan, head of the University clinical department for plastic, reconstructive, aesthetic surgery at the UKC Ljubljana. Ahčan performed the demanding reconstruction together with his colleague Vojko Didanovič, a maxillofacial and oral surgeon.

The patient had a total nose amputation due to invasive skin cancer, which resulted in great functional and aesthetic problems. A plastic prosthetic caused her numerous difficulties. 'I always had a cold, the glue was constantly irritating my skin. I sometimes simply did without my artificial nose at home. So I started to search for information from all around the world, to see what the possibilities were for a transplant. I learned that a transplant was not an option for me due to the cancer. I started looking for more information and so I asked Dr Ahčan to at least tell me what was actually possible,' explained the patient in a video shown at the press conference. The possibility of a nose reconstruction came about after numerous discussions and examinations. ‘When I received this piece of information, it seemed to me there was new hope.’

According to Ahčan, nose reconstruction after a total amputation is one of the most challenging reconstruction surgeries. Multi-dimensional thinking is required in the case of reconstruction, a firm framework and soft tissue need to be secured, as well as a revived bone, nerve-rich skin and a permanent result. He said they always need to ensure good function and a nice aesthetic appearance.
‘When professor Ahčan called me, it was clear to me that we would need to solve several problems. The nose is a very complex structure on the face; it is complex three-dimensionally, consisting of three layers,’ explained Didanovič, adding that the forehead lobe operation goes back more than 2,500 years.

Two stages of a demanding surgery
The total reconstruction was performed in two stages and the two surgeries lasted nine and eight hours. The main surgery was performed in the beginning of the year: the first one during the Christmas period, while small corrections were carried out in March and April.
After thorough preparations the doctors initially made a 3D print model of the facial defect, of various layers and of the structure of the nose to get a match to the actual state.

On the basis of the 3D model, tissue and skin were then modelled on the forearm to build a nerve-rich nose with blood supply using precise surgical procedures. All of that was done on the patient’s forearm. A new nose remained on her forearm for 30 days until it was healed and became a nerve-rich part of the body. During the last stage of the first surgery a skin-stretching aid was placed on the patient’s forehead. When the nose was placed on her face, it was covered with stretched skin to prevent scarring.

The transfer of the nose to the face a month later
Around one month later another surgery was performed, lasting eight hours. The new nose, grown from bone and soft tissue, was transferred to the face and fixed in place with microplates and titanium screws.

The cost of the whole surgical procedure is estimated at around 58,000 euros, and the UKC will only receive a lump sum of 12,000 euros from the health insurance. However, Ahčan stresses that they rather not think about the finances, as it is an issue which always brings them down. Their main goal is to shed light on the satisfied patient after such a demanding, and at the same time successful, procedure.