CC BY 4.0 · Surg J (N Y) 2018; 04(02): e55-e61
DOI: 10.1055/s-0038-1639581
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comprehensive Algorithm for Nasal Ala Reconstruction: Utility of the Auricular Composite Graft

Collin Chen
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology- Head and Neck Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri
Ruchin Patel
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology- Head and Neck Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri
John Chi
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology- Head and Neck Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

01 November 2017

19 February 2018

Publication Date:
18 April 2018 (online)


Defects of the nasal ala are challenging to reconstruct, given its complex three-dimensional structure. Successful repair of these defects needs to provide aesthetic symmetry and preserve nasal function. A wide variety of reconstructive options have been described for nasal ala defects, ranging from skin grafts to locoregional flaps, and also includes the auricular composite graft. However, there are currently no comprehensive guidelines for nasal ala repair, and the versatile role of the auricular composite graft has not been well defined. In this review, we aim to provide a comprehensive algorithm to guide repair of nasal ala defects. Additionally, we compare our experience using the auricular composite graft with the available literature to better define its utility in nasal ala repair.

  • References

  • 1 Zenga J, Chi JJ. Reconstruction of the intranasal lining. Facial Plast Surg 2017; 33 (01) 67-73
  • 2 Scheithauer MO, Rotter N, Lindemann J, Schulz M, Rettinger G, Veit JA. The auricle's cavum conchae composite graft in nasal reconstruction. Am J Rhinol Allergy 2013; 27 (02) e53-e57
  • 3 Driscoll BP, Baker SR. Reconstruction of nasal alar defects. Arch Facial Plast Surg 2001; 3 (02) 91-99
  • 4 Konig F. On filling defects of the nostril wall. Berl Klin Wochenschr 1902; 39: 137
  • 5 Sheen JH, Sheen A. Adjunctive technique. In: Sheen JH, Sheen A. , eds. Aesthetic Rhinoplasty. 2nd ed. St Louis: Mosby; 1987: 440-444
  • 6 Ponti L, Ponti G, Serafini P. Osteocartilaginous flap technique for acquired and congenital saddle nose deformities. Plast Reconstr Surg 1993; 92 (03) 431-442
  • 7 Zilinsky I, Winkler E, Jacobs DI, Josef H, Jermy T, Orenstein A. Turnover forehead flap combined with composite crus of helix graft for partial nasal reconstruction. Plast Reconstr Surg 1999; 103 (01) 192-196
  • 8 Cordova A, Di Lorenzo S, Moschella F. “Composite graft”: a simple option for nasal lining. Int J Dermatol 2007; 46 (04) 417-421
  • 9 Klinger M, Maione L, Villani F, Caviggioli F, Forcellini D, Klinger F. Reconstruction of a full-thickness alar wound using an auricular conchal composite graft. Can J Plast Surg 2010; 18 (04) 149-151
  • 10 Manafi A, Eslami Shahr Babaki A, Mehrabani G, Shahlaee A, Manafi A. Can we add auricular composite graft to our rhinoplasty armamentarium?. World J Plast Surg 2013; 2 (01) 33-40
  • 11 Ortins-Pina A, Teixeira AI, Sanches M, Gouveia AI, Filipe PL, Silva JM. Nasal ala reconstruction: surgical conundrum. J Cutan Aesthet Surg 2017; 10 (01) 55-58
  • 12 Adams DC, Ramsey ML. Grafts in dermatologic surgery: review and update on full- and split-thickness skin grafts, free cartilage grafts, and composite grafts. Dermatol Surg 2005; 31 (8 Pt 2): 1055-1067
  • 13 McCluskey PD, Constantine FC, Thornton JF. Lower third nasal reconstruction: when is skin grafting an appropriate option?. Plast Reconstr Surg 2009; 124 (03) 826-835
  • 14 Singh DJ, Bartlett SP. Nasal reconstruction: aesthetic and functional considerations for alar defects. Facial Plast Surg 2003; 19 (01) 19-28
  • 15 Vuyk HD, Watts SJ, Kirkland PM. Nasal reconstruction. In: Vuyk HD, Lohuis PJFM, Hodder A. , eds. Facial Plastic and Reconstructive Surgery. London: Hodder Arnold; 2006: 455-480
  • 16 Burget GC, Menick FJ. Nasal reconstruction. In: Burget GC, Menick FJ. , eds. Aesthetic Reconstruction of the Nose. St. Louis: Mosby; 1994: 246-250
  • 17 Thornton JF, Griffin JR, Constantine FC. Nasal reconstruction: an overview and nuances. Semin Plast Surg 2008; 22 (04) 257-268
  • 18 Lindsey WH. Reliability of the melolabial flap for alar reconstruction. Arch Facial Plast Surg 2001; 3 (01) 33-37
  • 19 Younger RAL. The versatile melolabial flap. Otolaryngol Head Neck Surg 1992; 107 (6 Pt 1): 721-726
  • 20 Arden RL, Nawroz-Danish M, Yoo GH, Meleca RJ, Burgio DL. Nasal alar reconstruction: a critical analysis using melolabial island and paramedian forehead flaps. Laryngoscope 1999; 109 (03) 376-382
  • 21 Correa BJ, Weathers WM, Wolfswinkel EM, Thornton JF. The forehead flap: the gold standard of nasal soft tissue reconstruction. Semin Plast Surg 2013; 27 (02) 96-103
  • 22 Teltzrow T, Arens A, Schwipper V. One-stage reconstruction of nasal defects: evaluation of the use of modified auricular composite grafts. Facial Plast Surg 2011; 27 (03) 243-248
  • 23 Maves MD, Yessenow RS. The use of composite auricular grafts in nasal reconstruction. J Dermatol Surg Oncol 1988; 14 (09) 994-999
  • 24 Harbison JM, Kriet JD, Humphrey CD. Improving outcomes for composite grafts in nasal reconstruction. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (04) 267-273
  • 25 Haas AF, Glogau RG. A variation of composite grafting for reconstruction of full-thickness nasal alar defects. Arch Dermatol 1994; 130 (08) 978-980
  • 26 Chandawarkar RY, Cervino AL, Wells MD. Reconstruction of nasal defects using modified composite grafts. Br J Plast Surg 2003; 56 (01) 26-32
  • 27 Davenport G, Bernard FD. Improving the take of composite grafts. Plast Reconstr Surg Transplant Bull 1959; 24 (02) 175-182
  • 28 Ratner D, Katz A, Grande DJ. An interlocking auricular composite graft. Dermatol Surg 1995; 21 (09) 789-792
  • 29 Symonds FC, Crikelair GF. Auricular composite grafts in nasal reconstruction: a report of 36 cases. Plast Reconstr Surg 1966; 37 (05) 433-437
  • 30 Sherris DA, Fuerstenberg J, Danahey D, Hilger PA. Reconstruction of the nasal columella. Arch Facial Plast Surg 2002; 4 (01) 42-46
  • 31 Baker SR. Nasal lining flaps in contemporary reconstructive rhinoplasty. Facial Plast Surg 1998; 14 (02) 133-144
  • 32 Murakami CS, Kriet JD, Ierokomos AP. Nasal reconstruction using the inferior turbinate mucosal flap. Arch Facial Plast Surg 1999; 1 (02) 97-100
  • 33 Zenga J, Kao K, Chen C. , et al. Titanium mesh nasal repair without nasal lining. Facial Plast Surg 2017; 33 (01) 52-57