Free Cartilage Grafts and Healing by Secondary Intention

Eerden, Paul A. van der; Verdam, Froukje J.; Dennis, Simon C. R.; Vuyk, H. D.

doi:10.1001/archfacial.2008.501

Cited by 30 publications

(14 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All procedures have potential complications, including this one. Van der Eerden and colleagues reported one instance of alar notching and one patient with hypertrophic scarring in their series 1 . We have found this to be a useful technique for any small‐ to medium‐sized defects of the alar subunit or nasal sidewall.…”

Section: Discussionmentioning

confidence: 72%

“…Van der Eerden and colleagues recently reported their experience with this technique in 13 patients, concluding that this repair is a viable option for small and deep defects of the alar subunit and nasal sidewall 1 . Rotter also noted positive results with his experience with more than 450 of these procedures (personal communication, June 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Second‐intention healing over cartilage has historically not been favored because of concerns about desiccation necrosis and aesthetic outcome. This notion has recently been dispelled 1 …”

mentioning

confidence: 99%

“…The use of free cartilage grafts in combination with second‐intention healing for surgery defects involving the ala allows the surgeon to recreate the alar subunit of the nose without large complex local flaps. This technique also adds support in the alar region and aims to prevent external valve collapse and alar retraction 1,2 …”

mentioning

confidence: 99%

See 3 more Smart Citations

Free Cartilage Grafts for Alar Defects Coupled with Secondary-Intention Healing

Campbell

Eisen

2011

Dermatologic Surgery

View full text Add to dashboard Cite

The authors have indicated no significant interest with commercial supporters.R epairing the alar subunit of the nose after Mohs micrographic surgery is a challenge and can be a lengthy procedure. The inability to let this cosmetic subunit heal by second intention because of alar retraction, nasal valve collapse, and unacceptable scar leads to long procedures involving flaps, grafts, and a combination of both to recreate the contour of the nose. Single-stage flaps create complex networks of scars running along the nose and can blunt the alar sulcus. Full-thickness skin grafts result in noticeable divots, color mismatch, and the possibility of alar distortion when used without cartilage. Many worry about the possibility of graft failure when skin and cartilage are combined during the repair if there is not an adequately sized wound bed. Second-intention healing over cartilage has historically not been favored because of concerns about desiccation necrosis and aesthetic outcome. This notion has recently been dispelled. 1The use of free cartilage grafts in combination with second-intention healing for surgery defects involving the ala allows the surgeon to recreate the alar subunit of the nose without large complex local flaps. This technique also adds support in the alar region and aims to prevent external valve collapse and alar retraction. 1,2 TechniqueThe alar defect and ipsilateral auricle are cleansed with chlorhexidine antiseptic solution and infiltrated with a mixture of 1% lidocaine and 1:1,00,000 epinephrine (AstraZeneca LP, Wilmington, DE). To determine the size of the cartilage that will be needed, the length of the defect is measured, and at least 6 mm is added to the measurement. The extra length is to ensure that the batten will fit snuggly into the recipient site and allow for the creation of subcutaneous pockets on each side of the defect from which the graft will receive additional blood supply. The cartilage will be slightly narrower than the defect, which will reduce the risk of alar rim elevation and help fill the defect.A rectangular skin flap is incised over the antihelix or conchal bowl and retracted to expose the cartilage. The rectangular incision creates a bigger window through which the cartilage is more easily excised than a simple linear incision and does not seem to compromise the aesthetics of the skin closure at the donor site. Although cartilage may be harvested from the conchal bowl or antihelix, using the conchal bowl for the cartilage batten will result in less-noticeable contour distortion of the donor site and is our current preference. Care is taken to preserve the perichondrium, and the cartilage batten is then placed into sterile saline while hemostasis is achieved at the donor site. The donor site flap is sewn back in place using a running cutaneous suture technique with 5-0 fast-absorbing gut (Ethicon,

show abstract

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Free Cartilage Grafts for Alar Defects Coupled with Secondary-Intention Healing

Campbell

Eisen

2011

Dermatologic Surgery

View full text Add to dashboard Cite

show abstract

“…Causes of failure in those cases (two), in which a conchal graft was utilized conceptually, could be attributable to graft fracture (more likely with elastic than hyaline cartilage) or graft malposition (failure to fully support lateral crural‐sesamoid complex). The use of additional cartilage as nonanatomical grafts in deep defects of the alar subunit was reported helpful at preventing valve collapse by van der Eerden10 in cases allowed to heal by secondary intention. We found no significant difference in nasal obstruction complaints in the 24 patients treated with cartilage grafts irrespective of whether they possessed through‐and‐through defects or had lining and crural cartilage intact.…”

Section: Discussionmentioning

confidence: 99%