Abstract: Objective To investigate amethod of repeated plastic reconstruction of the nose in patients after a failed or unsatisfactory initial reconstruction that totally destroyed the forehead tissue.Methods From January 2008 to January 2010, 3 cases with failed nasal reconstructions were repaired using the upper arm skin tube by four-stage.During StageⅠ,a skin tube was created using the internal aspectof the leftupper arm(18 cm×8 cm).During StageⅡ,which occurred three weeks after Stage I,the top end of the skin tube was severed and moved to the nasion.During StageⅢ,which occurred three weeks after Stage II,the skin tube was removed from the upper arm,forming a flap,which was trimmed to a three-lobed shape and folded inwards to construct the nasal alars,tip and columella.The seventh and eighth costal cartilageswere obtained to form an“L”-shaped scaffold.During StageⅣ,which occurred three weeks after StageⅢ,pedicle division and trimm ing were conducted.Resu lts The operation was successful in all three patients,and all the patientswere followed up for 1 to 2 years. The color and texture of the reconstructed noses were matched well to the surrounding skin,satisfactory appearance and ventilatory function were both achieved.Conclusion For patients with failed nasal reconstruction and destroyed forehead tissue or who are firmly against leaving amark in the forehead,the application of the upper arm skin tube for total nasal reconstruction is an effectivemethod.

Key words: Nasal reconstruction, Failed case, Upper arm skin tubemethod