Reconstruction of Distal Nasal Defects With a Large Postauricular Skin-Fat-Fascia Composite Graft.
Journal
Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336
Informations de publication
Date de publication:
01 Jan 2022
01 Jan 2022
Historique:
pubmed:
22
10
2021
medline:
7
1
2022
entrez:
21
10
2021
Statut:
ppublish
Résumé
Composite grafts have previously been reported to achieve a good outcome for nasal defect repair, but composite grafts have greater metabolic needs than simple skin. Therefore, the traditionally recommended size of a composite graft for nasal reconstruction is less than 1.5 cm in diameter. However, the distal nose is generally well supplied with blood vessels, which might support the use of larger composite grafts in such a highly vascularized recipient site. The aim of the article is to investigate whether a large skin-fat-fascia composite graft (larger than 2.0 cm) is viable for the repair of partial-thickness nasal defects. From October 2017 to December 2019, 13 patients with partial-thickness nasal defects underwent nasal reconstruction using a large postauricular skin-fat-fascia composite graft. Cases were followed up for 3 to 14 months postoperatively. The aesthetic outcome was evaluated in comparison with preoperative digital images. Skin-fat-fascia composite grafts survived without graft necrosis, dermal fibrosis, or skin contraction in all cases. Favorable aesthetic outcomes were obtained in all patients, and no further revision surgery was need. A postauricular composite graft larger than 2.0 cm is a safe and effective reconstruction approach for partial-thickness nasal defects. This technique offers significant advantages in terms of no additional facial scar, no visible asymmetry on the face, no additional surgery for revision, and with mild scar in the donor site of the postauricular region.
Sections du résumé
BACKGROUND
Composite grafts have previously been reported to achieve a good outcome for nasal defect repair, but composite grafts have greater metabolic needs than simple skin. Therefore, the traditionally recommended size of a composite graft for nasal reconstruction is less than 1.5 cm in diameter. However, the distal nose is generally well supplied with blood vessels, which might support the use of larger composite grafts in such a highly vascularized recipient site. The aim of the article is to investigate whether a large skin-fat-fascia composite graft (larger than 2.0 cm) is viable for the repair of partial-thickness nasal defects.
METHODS
From October 2017 to December 2019, 13 patients with partial-thickness nasal defects underwent nasal reconstruction using a large postauricular skin-fat-fascia composite graft. Cases were followed up for 3 to 14 months postoperatively. The aesthetic outcome was evaluated in comparison with preoperative digital images.
RESULTS
Skin-fat-fascia composite grafts survived without graft necrosis, dermal fibrosis, or skin contraction in all cases. Favorable aesthetic outcomes were obtained in all patients, and no further revision surgery was need.
CONCLUSIONS
A postauricular composite graft larger than 2.0 cm is a safe and effective reconstruction approach for partial-thickness nasal defects. This technique offers significant advantages in terms of no additional facial scar, no visible asymmetry on the face, no additional surgery for revision, and with mild scar in the donor site of the postauricular region.
Identifiants
pubmed: 34670965
doi: 10.1097/SAP.0000000000002947
pii: 00000637-202201000-00010
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
49-53Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest and sources of funding: All authors hereby declare not to have any potential conflict of interests. Each author participated sufficiently in the work to take public responsibility for the content and agree to its publication.
Références
Tanini S, Lo Russo G. V-shaped Internal nasal vestibular flap for reconstruction of iatrogenic columellar defect. Plast Reconstr Surg Glob Open . 2018;6:e1604.
Guesnier M, Claveleau X, Longeac M, et al. A new flap combination for reconstruction of lower nasal dorsum and supra-tip skin defects. Arch Plast Surg . 2019;46:480–483.
Jayasekera PSA, Hackett C, Oliphant T, et al. Use of a proximal peng flap for reconstruction of the nasal dorsum in 14 patients. Dermatol Surg . 2019;45:1704–1706.
Cecchi R, Troiano G. Forehead flaps for nasal reconstruction: a single-center experience. Dermatol Ther . 2017;30. doi: 10.1111/dth.12475. Epub 2017 Feb 20.
doi: 10.1111/dth.12475.
Skaria AM. Halberd flap for combined nose tip and columella repair. Dermatol Surg . 2019;45:466–467.
Goldman GD. Reconstruction of the nasal infratip, columella, and soft triangle. Dermatol Surg 40 Suppl . 2014;9:S53–S61.
Rohrer TE, Dzubow LM. Conchal bowl skin grafting in nasal tip reconstruction: clinical and histologic evaluation. J Acad Dermatol . 1995;33:476–481.
Adams C, Ratner D. Composite and free cartilage grafting. Dermatol Clin . 2005;23:129–140 vii.
Haas AF, Glogau RG. A variation of composite grafting for reconstruction of full-thickness nasal alar defects. Arch Dermatol . 1994;130:978–980.
Guzman AK, Bhatt MD, Sobanko JF, et al. Intrasubunit V-Y muscle sling myocutaneous island advancement flap for small defects isolated to the nasal ala. Dermatol Surg . 2020;46:546–553.
Lane JE, Bob Hsia LL, Merritt BG. Reconstruction of large transmural nasal defects with a nasolabial turnover interpolation flap. Dermatol Surg . 2020.
Goldman A, Wollina U. Dog bite injury—alar repair with composite graft. Wien Med Wochenschr . 2018;168:261–264.
Ratner D, Katz A, Grande DJ. An interlocking auricular composite graft. Dermatol Surg . 1995;21:789–792.
Field LM. Nasal alar rim reconstruction utilizing the crus of the helix, with several alternatives for donor site closure. J Dermatol Surg Oncol . 1986;12:253–258.
Chandawarkar RY, Cervino AL, Wells MD. Reconstruction of nasal defects using modified composite grafts. Br J Plast Surg . 2003;56:26–32.
Memar OM, Caughlin B. Nasal reconstruction of post-Mohs defects >1.5 cm in a single cosmetic subunit under local anesthesia by a combination of plastic surgeon and mohs surgeon team: a cross-sectional study and review of algorithmic nasal defect closures. Plast Reconstr Surg Glob Open . 2019;7:e2277.
Inchingolo F, Tatullo M, Marrelli M, et al. Clinical case-study describing the use of skin-perichondrium-cartilage graft from the auricular concha to cover large defects of the nose. Head Face Med . 2012;8:10.
Rohrich RJ, Gunter JP, Friedman RM. Nasal tip blood supply: an anatomic study validating the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surgery . 1995;95:795–799;discussion 800–791.
Duisit J, Maistriaux L, Gerdom A, et al. Nose and lip graft variants: a subunit anatomical study. Plast Reconstr Surg . 2018;141:751–761.