Can we add auricular composite graft to our rhinoplasty armamentarium?

Abstract

Background: The ala of the nose, with its particular texture and characteristics, poses both aesthetically and functionally intriguing challenges and is rather problematic regarding choices for reconstructive methods. Both flaps and grafts have been used to restore natural structure of nasal ala. The present study summarizes a ten-year experience of reconstructive surgery using small composite grafts from non-cartilage bearing tissues, and large composite grafts, containing cartilaginous tissue, with a mean follow-up of 4 years and 8 months.

Methods: Cumulatively 56 patients were reported. Some of them required surgery due to previous cosmetic rhinoplasty. In 47 of the cases, a small graft from the non-cartilage bearing junction of ear lobule to helical rim sufficed. Nine patients had rather large defects for which grafts were harvested from the helical root. Donor sites were primarily closed and grafts were implanted in place in a single, rapid session.

Results: All small grafts had excellent take. Of 9 large grafts, 5 had excellent take, three had acceptable, and one, in a male smoker, failed to take. During follow-up, no gross deformity or poor scar was detected in either donor or recipient site.

Conclusions: We have demonstrated that using both large and small auricular composite grafts has favorable long term results for reconstruction of alar rim deformities. However, use of small grafts seems more beneficial and applicability of large grafts requires further studies.

Keywords: Alar rim; Armamentarium; Auricular composite; Graft; Reconstruction; Rhinoplasty.

Fig. 1

A suitable graft size is marked at the junction of helix and lobule. (b) The graft was harvested, (c) the donor site was closed primarily, and (d) the composite graft (e) was placed at the incised alar rim defect resulting in normal appearing nostrils

Fig. 2

A patient with facial burn scars, with a defect at the right alar margin, on profile view, (a) before and (b) after reconstruction with composite graft and z-plasties. Images (c) and (d) are three-quarters view of the same patient demonstrating acceptable take and appearance

Fig. 3

A lady who complained of asymmetric nostrils and other deformities following rhinoplasty. Images (a) and (b) show her on frontal view, before and after tertiary rhinoplasty and surgical correction with small composite grafts on the right alar rim, respectively. Figures (c) and (d) show the same patient, on three-quarters view. Figure (e) shows a close-up view of the same patient 10 days after surgery. The site of graft is indicated by an arrow. Figures (f) and (g) show basal view (h) and (i) show profile view

Fig. 4

A lady presenting with asymmetry in nostrils in addition to dissatisfaction with previous rhinoplasty and face-lift, (a) before, and (b) after secondary rhinoplasty, reconstruction with a small composite graft, face-lift and lipoplasty, on frontal view. Additional images show frontal views of her, when presenting for the first time (c), after secondary rhinoplasty and face-lift (d), and three months after lipoplasty and implementing a composite graft on the right ala (e). Images (f), (g) and (h) show the same individual on profile view

Fig. 5

A young lady who had undergone two previous rhinoplasties, and the surgical and unnatural appearance of nasal tip and nostrils was her main complaint. Images (a) and (b) show her after tertiary rhinoplasty and composite grafting, on both sides, on frontal view. Figures (c) and (d) show her on basal view (e) and (f) show profile view (g) and (h) show three-quarter view