Large Auricular Chondrocutaneous Composite Graft for Nasal Alar and Columellar Reconstruction

Background Among the various methods for correcting nasal deformity, the composite graft is suitable for the inner and outer reconstruction of the nose in a single stage. In this article, we present our technique for reconstructing the ala and columella using the auricular chondrocutaneous composite graft.

Methods From 2004 to 2011, 15 cases of alar and 2 cases of columellar reconstruction employing the chondrocutaneous composite graft were studied, all followed up for 3 to 24 months (average, 13.5 months). All of the patients were reviewed retrospectively for the demographics, graft size, selection of the donor site and outcomes including morbidity and complications.

Results The reasons for the deformity were burn scar (n=7), traumatic scar (n=4), smallpox scar (n=4), basal cell carcinoma defect (n=1), and scar contracture (n=1) from implant induced infection. In 5 cases of nostril stricture and 6 cases of alar defect and notching, composite grafts from the helix were used (8.9×12.5 mm). In 4 cases of retracted ala, grafts from the posterior surface of the concha were matched (5×15 mm). For the reconstruction of the columella, we harvested the graft from the posterior scapha (9×13.5 mm). Except one case with partial necrosis and delayed healing due to smoking, the grafts were successful in all of the cases and there was no deformity of the donor site.

Conclusions An alar and columellar defect can be reconstructed successfully with a relatively large composite graft without donor site morbidity. The selection of the donor site should be individualized according to the 3-dimensional configuration of the defect.

Keywords

Ear - Nose - Transplants

This article was presented at the 1st Research and Reconstructive forum on May 12-13, 2011 in Daejon, Korea.

Publication History

Received: 23 March 2012

Accepted: 21 May 2012

Article published online:
01 May 2022

• REFERENCES

• 1 Brown JB, Cannon B. Composite free grafts of two surfaces of skin and cartilage from the ear. Ann Surg 1946; 124: 1101-1107
• 2 Lehman Jr JA, Garrett Jr WS, Musgrave RH. Earlobe composite grafts for the correction of nasal defects. Plast Reconstr Surg 1971; 47: 12-16
• 3 Son D, Jeong H, Choi T. et al. A new mechanism associated with compositae graft success. J Plast Reconstr Aesthet Surg 2010; 63: 1900-1909
• 4 Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985; 76: 239-247
• 5 Bayramicli M. A new classification system and an algorithm for the reconstruction of nasal defects. J Plast Reconstr Aesthet Surg 2006; 59: 1222-1232
• 6 Driscoll BP, Baker SR. Reconstruction of nasal alar defects. Arch Facial Plast Surg 2001; 3: 91-99
• 7 Maves MD, Yessenow RS. The use of composite auricular grafts in nasal reconstruction. J Dermatol Surg Oncol 1988; 14: 994-999
• 8 McLaren LR. Nasolabial flap repair for alar margin defects. Br J Plast Surg 1963; 16: 234-238
• 9 Menick FJ. Nasal reconstruction: forehead flap. Plast Reconstr Surg 2004; 113: 100e-111e
• 10 Shenaq SM, Dinh TA, Spira M. Nasal alar reconstruction with an ear helix free flap. J Reconstr Microsurg 1989; 5: 63-67
• 11 Singh DJ, Bartlett SP. Aesthetic management of the ear as a donor site. Plast Reconstr Surg 2007; 120: 899-908
• 12 Cheon YW, Park BY. Long-term evaluation of elongating columella using conchal composite graft in bilateral secondary cleft lip and nose deformity. Plast Reconstr Surg 2010; 126: 543-553
• 13 Parkhouse N, Evans D. Reconstruction of the ala of the nose using a composite free flap from the pinna. Br J Plast Surg 1985; 38: 306-313
• 14 Kwon HJ, Han KH, Kim JH. et al. Photogrammetry based on standardized clinical photography using cephalostat: comparison with anthropometric analysis. J Korean Soc Plast Reconstr Surg 2007; 34: 24-36