Use of Outsized Composite Chondrocutaneous Grafts in Conjunction With Dermal Turnover Flaps for Reconstruction of Full-Thickness Alar Defects

Abstract

Chondrocutaneous (ChC) grafts have been used for nasal alar reconstruction for years. One of the consequences for using these grafts is the restriction in dimensions. In this study, we presented our results in which ChC grafts bigger than 20 mm in length have been used in conjunction with a dermal turnover flap for full-thickness alar subunit defects. Technical details and results of 8 alar subunits reconstructions in 8 patients were evaluated. Follow-up period ranged from 10 to 27 months, with a mean of 18.3 months. We achieved satisfactory results without partial or total graft failure. Finally, surgeons can safely use outsized ChC composite grafts with this type of design, for successful alar subunit reconstruction.

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 ]…”

“…Indeed, in a series of eight cases, Pilanci et al . [ 21 ] reported alar margin reconstruction with composite grafts of sizes ranging 11 mm × 24 mm, using turnover hinge flaps to augment blood supply. The 11 mm height in their cases exceeds an accepted safe limit, but they seem to have obtained complete success using turnover flaps with ‘combination’ grafts.…”

“…[ 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. Cooling has been considered impractical over a period of 14 days[ 25 ] as was originally recommended.…”

“…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.…”

Auricular Composite Chondrocutaneous Grafts in the Repair of Nasal Alar Rim Defects

“…Moreover, the procedure is less reliable than either the local or regional flap techniques2,3, and can only be used on healthy recipient sites3. Smoking increases the risk of postoperative ischemia, which can result in poor wound healing or tissue necrosis1.…”