Rhinoplasty - Auricular composite graft

Considerations

• • Indications 

    • Severe alar retraction 

    • External alar defect reconstruction 

    • Columellar reconstruction 

    • Cleft nasal alar deformity 

    • 2012: Large Auricular Chondrocutaneous Composite Graft for Nasal Alar and Columellar Reconstruction

    • 2014: Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience

    • 2014: Evaluation of the Use of Auricular Composite Graft for Secondary Unilateral Cleft Lip Nasal Alar Deformity Repair

    • 2018: Comprehensive Algorithm for Nasal Ala Reconstruction: Utility of the Auricular Composite Graft

  • Surface - anterior, posterior, helix

  • Laterality - ipsilateral, contralateral 

    • For alar retraction (intranasal defects) - choose the anterolateral surface, just inferior to the inferior crus (use the concha cymba), of the contralateral ear 

  • Donor site closure

    • For smaller defects, perform primary closure

    • 2018: Primary Closure Technique for Conchal Auricular Composite Graft Donor Site

    • For larger defects, perform "revolving door" post-auricular flap

Preparation

Procedure

• • Secure the graft using 6-0 Plain Gut 

  • Apply a cotton ball or other light pressure dressing intra-nasally for 1-5 days  

Sample operative report

Post-op

Pearls & Pitfalls

High-Yield

Links