Reconstructive Strategies in Acute Nasal Soft-Tissue Trauma: A Narrative Review and Subunit-Based Algorithm

While several subunit-based algorithms exist for oncologic nasal defects, particularly following Mohs micrographic surgery, comparable guidance for acute nasal soft-tissue trauma remains lacking.Acute traumatic defects present distinct challenges related to tissue viability, contamination, tissue salvage, timing of reconstruction, and variable patterns of tissue loss.This narrative review synthesizes the contemporary literature on acute nasal soft-tissue reconstruction and proposes a practical clinical framework for decision-making.Recurring reconstructive principles identified in the literature include preservation and salvage of viable tissue, assessment of wound suitability for definitive reconstruction, restoration of contour and airway function, and consideration of defect location, size, depth, and structural or lining involvement.Small superficial defects may be managed with secondary intention, primary closure, skin grafting, or local flaps, whereas larger, deeper, and multisubunit defects may require regional flaps, structural support, and staged reconstruction.Based on these principles, a trauma-specific algorithm is proposed that prioritizes initial trauma assessment, salvage of avulsed or amputated tissue when feasible, and determination of wound readiness before proceeding to subunit-and defect-based reconstructive selection.By translating heterogeneous and predominantly low-level evidence into a structured approach, this framework addresses a gap in the current literature and may assist surgeons in the management of acute nasal soft-tissue injuries.