Full-Thickness Skin Graft Overlying a Separately Harvested Auricular Cartilage Graft for Nasal Alar Reconstruction

Zopf, David; Iams, Wade T.; Kim, Jennifer C.; Baker, Shan R.; Moyer, Jeffrey S.

doi:10.1001/jamafacial.2013.25

Cited by 21 publications

(19 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They found that a full-thickness skin graft and a separately harvested auricular cartilage graft were valuable and reliable tools for reconstructing deep nasal alar defects that require support to prevent alar retraction or collapse. 25 As every surgeon group in our study (chief, consultants, senior residents, and assistant doctors) has almost the same mean score, we can state that in our population there was no correlation between experience of the surgeon and the operative result.…”

Section: Discussionmentioning

confidence: 52%

Skin-Fat-Graft: A Simple Tool for Reconstruction of Small Deep Defects of the Nose

2014

View full text Add to dashboard Cite

Small deep defects of the nose after resection of benign or malignant skin tumors are a common challenge in facial plastic surgery daily routine. The use of local flaps has several disadvantages for what reason they are a minor or no option especially in certain localizations in the lower third of the nose. Many elder patients suffer from comorbidities where complex more-staged reconstructional procedures drop out. We present a technique of nasal defect closure with a skin-fat composite graft. Between April 2010 and July 2013, we treated 42 patients with a total of 46 skin-fat-grafts to the nose. We reevaluated the esthetic and functional outcome in a retrospective analysis. In 80% of the cases, the results were rated excellent to satisfactory, 20% fair to poor. Reasons for worse validation were color and contour differences of grafts and surrounding tissue as well as alar retraction in very few cases. Nevertheless, we consider skin-fat-grafts to be a useful tool in single-layer nasal reconstruction in defects of smaller size.

show abstract

Section: Discussionmentioning

confidence: 52%

Skin-Fat-Graft: A Simple Tool for Reconstruction of Small Deep Defects of the Nose

2014

View full text Add to dashboard Cite

show abstract

“…In a recent prospective study, the aesthetic outcome of 20 cases in which a full‐thickness skin graft and a separately harvested auricular cartilage were used for nasal ala reconstruction was assessed . Good‐to‐excellent outcomes were present when assessed by three surgeons independently.…”

Section: Discussionmentioning

confidence: 99%

Full-thickness skin grafts for surgical defects of the nasal ala - a comprehensive review, approach and outcomes of 186 cases over 9 years

Tan¹,

Mortimer²,

Salmon³

2014

Br J Dermatol

View full text Add to dashboard Cite

SummaryBackground Skin cancers of the nasal ala are commonly encountered in dermatological surgery. Various techniques have been described to reconstruct surgical defects of the ala, including melolabial transposition flaps, interpolated melolabial flaps, bilobed and trilobed transposition flaps, island pedicle flaps and spiral flaps. Full-thickness skin grafts have received little attention in the reconstructive literature.Objectives We present our experience with full-thickness skin grafts for the reconstruction of partial thickness defects of the nasal ala in the largest series to date. Methods A retrospective analysis of the Mohs micrographic surgery database over a 9-year period was performed. All cases of full-thickness skin grafts for reconstruction of the nasal ala were identified. Defect location, size and any postoperative complications were noted. All patients were reviewed at the time of suture removal, at 3 and 6 weeks postoperatively and at 1 year. Results There were 186 cases in total in 181 patients (88 men and 93 women). Their ages ranged from 31 to 88 years with a mean of 65 years (median 66). Defect size varied from 0Á3 9 0Á4 cm to 2Á0 9 2Á7 cm, with the average defect size measuring 1Á0-1Á2 cm in diameter. Thirty-six per cent (67 of 186) of cases underwent postoperative dermabrasion, and 8% (14 of 186) received postoperative intralesional triamcinolone. The incidence of graft failure and infection was low. Good-to-excellent cosmetic results were seen in all patients and postoperative complications were uncommon and minor. Conclusions The use of full-thickness skin grafts for defects of the nasal ala is a simple and versatile reconstructive option with excellent functional and aesthetic outcomes.

show abstract

“…4,5 Along the alar region, this challenge derives from the contour of the cartilage and the long free margin of the inferior rim, which can become misshapen under the forces of wound contracture. 4,8,19 Even the lateral soft tissue can fall victim to these stresses and, without adequate structural support, can lead to internal nasal valve collapse. 8,18 This outcome underscores the need to evaluate not only the defect location and size but also the extent of tissue elevation required for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Functional Nasal Reconstruction Using Structural Reinforcement

Ezzat

Liu

2017

JAMA Facial Plast Surg

View full text Add to dashboard Cite

IMPORTANCE Nasal reconstruction after Mohs surgery is a unique challenge in that it must satisfy both functional and aesthetic goals. Despite some advocacy in the literature for using structural reinforcement to achieve both functional and aesthetic outcomes in soft-tissue reconstruction, no study has validated this claim by comparing reconstruction with and without structural support. OBJECTIVE To evaluate the effectiveness of and need for structural reinforcement when reconstructing the nasal alar and sidewall subunits. DESIGN, SETTING, AND PARTICIPANTS This study was a retrospective review of the medical records of 190 patients 18 years or older who underwent nasal reconstruction after Mohs surgery in a tertiary care academic center between January 1, 2013, and August 31, 2015. Data on each patient included demographics, comorbidities, smoking status, details of the lesion, size of defect, subunits involved, and reconstructive technique. Patients were divided into 2 cohorts composed of those who had reconstruction with structural reinforcement (ie, cartilage grafting or suspension suture) and those with only soft-tissue reconstruction. Patients with nasal obstruction from the functional collapse of the reconstructed area and no history of nasal obstruction were included (n = 38). Patients who had a follow-up of less than 2 months, no alar or sidewall involvement, nasal obstruction secondary to turbinate hypertrophy, septal deflection or other nonstructural causes, and incomplete documentation for analysis were excluded (n = 102). MAIN OUTCOMES AND MEASURES Rates of postoperative nasal obstruction secondary to nasal sidewall collapse and need for revision surgery. RESULTS Of the 38 patients who met the inclusion criteria, 22 were men and 16 were women with a mean (range) age of 64.5 (35-92) years. Twenty-three patients (61%) underwent reconstruction by a facial plastic surgeon and 15 (39%) by 2 dermatologic surgeons. Three (8%) underwent reconstruction without reinforcement and experienced postoperative nasal obstruction. The mean size of reconstructed defects that resulted in nasal valve collapse was 2.1 cm in diameter (range, 1.2-2.6 cm). Defect size was associated with incidence of postoperative nasal obstruction. For defects greater than 1.2 cm in diameter, patients reconstructed without reinforcement had a statistically significant increase of nasal obstruction secondary to functional nasal collapse compared with patients reconstructed with reinforcement (3 of 14 [21%] vs 0 of 17; 95% CI, 0.005-0.358; P = .04). CONCLUSIONS AND RELEVANCE Nasal defects greater than 1.2 cm in diameter and involving the alar and sidewalls were associated with lower incidence of postoperative nasal obstruction when a structural reinforcement technique was used in reconstruction. The findings of this study support the structural reinforcement of the nasal functional subunits during Mohs reconstructive surgery to achieve optimal outcomes. LEVEL OF EVIDENCE 3.

show abstract

Full-Thickness Skin Graft Overlying a Separately Harvested Auricular Cartilage Graft for Nasal Alar Reconstruction

Cited by 21 publications

References 7 publications

Skin-Fat-Graft: A Simple Tool for Reconstruction of Small Deep Defects of the Nose

Skin-Fat-Graft: A Simple Tool for Reconstruction of Small Deep Defects of the Nose

Full-thickness skin grafts for surgical defects of the nasal ala - a comprehensive review, approach and outcomes of 186 cases over 9 years

Comparative Study of Functional Nasal Reconstruction Using Structural Reinforcement

Contact Info

Product

Resources

About