D Ratner1, A Katz, D J Grande. 1. Department of Dermatology, Lahey Clinic, Burlington, Massachusetts 01805, USA.
Abstract
BACKGROUND: Full-thickness defects of the nasal alar rim are relatively common following Mohs micrographic surgery for the treatment of long-standing or recurrent skin tumors. Composite grafts provide an excellent cosmetic and functional alternative for the repair of such defects. OBJECTIVE: A useful technique of auricular composite graft placement for reconstruction of full-thickness nasal alar rim defects is described. METHODS: The cartilaginous portion of the graft is extended beyond the borders of the soft tissue defect so that two cartilaginous pegs frame the lateral aspects of the graft. These pegs are then inserted into pockets prepared within the alar tissue of both sides of the defect, such that the graft interlocks with its recipient bed. A series of diagrams as well as a set of photographs from a representative case are provided, along with accompanying commentary, so as to enable the surgeon to incorporate this technique easily into his/her practice. CONCLUSION: The interlocking auricular composite graft technique permits increased graft stability, with decreased shearing forces of the graft over its recipient bed, and a larger surface area for revascularization, resulting in an increased probability of graft survival. This technique provides an elegant single stage alternative to current reconstructive techniques for full-thickness nasal alar rim defects measuring less than 1.5 cm in diameter.
BACKGROUND: Full-thickness defects of the nasal alar rim are relatively common following Mohs micrographic surgery for the treatment of long-standing or recurrent skin tumors. Composite grafts provide an excellent cosmetic and functional alternative for the repair of such defects. OBJECTIVE: A useful technique of auricular composite graft placement for reconstruction of full-thickness nasal alar rim defects is described. METHODS: The cartilaginous portion of the graft is extended beyond the borders of the soft tissue defect so that two cartilaginouspegs frame the lateral aspects of the graft. These pegs are then inserted into pockets prepared within the alar tissue of both sides of the defect, such that the graft interlocks with its recipient bed. A series of diagrams as well as a set of photographs from a representative case are provided, along with accompanying commentary, so as to enable the surgeon to incorporate this technique easily into his/her practice. CONCLUSION: The interlocking auricular composite graft technique permits increased graft stability, with decreased shearing forces of the graft over its recipient bed, and a larger surface area for revascularization, resulting in an increased probability of graft survival. This technique provides an elegant single stage alternative to current reconstructive techniques for full-thickness nasal alar rim defects measuring less than 1.5 cm in diameter.