Managing the Ear as a Donor Site For Composite Graft in Nasal Reconstruction

Abstract

Reconstruction of multilayer defects of the lower nose, using composite grafts from the ear is a widespread technique. Little information exists about important aspects of managing the ear as a donor site for composite grafts. In a retrospective study, patient data were worked up concerning special preoperative planning features (donor site, recipient site), defect closure techniques, donor site morbidity, and esthetic and functional long-term results. One hundred ten composite grafts from the auricle were harvested for different defects at the lower nose. Skin and soft-tissue defect reconstruction at the auricle was carried out by tissue advancement in 43 cases or local flaps in 66 cases. Donor site morbidity was low (5 cases of delayed wound healing, 1 abscess). No flap necrosis occurred. Long-term follow-up (2-5 years) revealed no esthetic or functional impairments. Composite graft harvesting from the auricle is safe with minimal donor site morbidity, proper implementation assumed.

Clinical case-study describing the use of skin-perichondrium-cartilage graft from the auricular concha to cover large defects of the nose

“…The technique for removal of the graft is very simple, leaves no trace and does not cause any residual functional deficit [5,6]. Insertion of the graft is easy and allows rapid solution of surgical problems that would otherwise demand more lengthy reconstruction or the use of microsurgery.…”

Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience

“…Whereas some authors, including us, have strongly reported that a graft size exceeding 10 mm is not suitable for reconstruction because of limited blood flow,[ 4 17 18 19 ] there are those who report high success with graft size between 10 and 20 mm[ 20 ] or even up to 25 mm. [ 15 21 ] Grafts exceeding 10 mm may well survive, but the success rate is about 65% for defects approaching 15 mm and <50% for grafts exceeding 15 mm. [ 18 ]…”

“…[ 11 ] Even though, there is no strong evidence to support cooling as a practice to enhance chances of graft survival, majority of authors have advocated its use. [ 9 15 17 24 ] At the same time, quite surprisingly, three series reporting high success with large sized composite grafts did not resort to cooling. [ 20 21 25 ] We feel this practice could be justified on the analogy of ‘warm ischemia time’ for a replantation, and is recommended by us if ambient temperatures are high, as is often the case in our country.…”

“…However, some other authors prefer to inject a combination of lidocaine and adrenaline to facilitate graft harvest. [ 15 21 24 ] It is possible that they indulge in this practice when advancement techniques become necessary to close a donor defect following harvest of a large graft. We feel infiltration leads to unnecessary disruption of the skin-perichondrial attachment at its margins.…”

“…Since then there have been more articles describing enhanced graft survival by cooling,[ 11 ] on bettering the aesthetic outcomes by appropriating the donor site of the composite graft,[ 12 13 ] and on management of the ear as a donor site. [ 14 15 ] In an era where a small piece of vascularised tissue can be made available for similar reconstruction,[ 16 ] the charm of simplicity of a composite graft lacks conviction if survival and aesthetic outcomes are not ensured. Majority of articles don’t directly report a success rate, but mention means and modifications to enhance it or limit donor site morbidity.…”