One-Stage Reconstruction of Nasal Defects: Evaluation of the Use of Modified Auricular Composite Grafts
12 May 2011 (online)
Complex nasal defects in the distal regions of the nose are cosmetically difficult to repair. In 70 patients over a period of 10 years, defects of the nasal ala and the soft triangle, nasal tip, columella, and columellar-lobular junction were reconstructed with modified auricular composite grafts. A randomized group of 40 of these patients was assessed after a mean of 55.5 months to evaluate the method's functional and cosmetic long-term results. The majority of the patients (60%, n = 48) had been treated primarily for basal cell carcinoma. Of all defects, 57% (n = 46) measured 2 to 3 cm in width and 43% (n = 34) 1 to 2 cm. Seventy-five percent (n = 60) of all defects were composite lesions involving skin, cartilage, and vestibular mucosa, in contrast to 25% (n = 20) involving skin and cartilage with intact vestibular skin. Two crucial technical modifications seemed to have improved survival for larger grafts: first, the use of hinge flaps from the margins of the defect to obtain a well-vascularized recipient bed and optimization of the raw contact surface; second, postoperative gentle scarification of the graft in combination with a constantly applied heparin solution decongests venous stasis normally seen in such grafts. This maneuver establishes a stable and early blood supply enhancing graft take. With this type of treatment, 67 (84%) grafts healed well without further complications, whereas 13 (16%) grafts developed complications, resulting in partial (n = 9) and total (n = 4) necrosis of the transplant. Six of these patients underwent a secondary reconstruction using another auricular composite graft. Long-term results of this method have turned out to be very satisfying in terms of functional and cosmetic outcome and patient acceptance.
Nasal defect - composite graft - hinge flap - cosmetic outcome