Nasal Reconstruction With Auricular Microvascular Transplant

EDITORIAL COMMENT

This technique extends the use of the procedure of selecting appropriate portions of the ear for nasal reconstruction. By accomplishing microvascular anastomosis, assurance of the survival of the segments is far more likely.

The ascending helix of the ear is a laminated structure composed of cartilage surrounded by a thin, tightly adherent layer of skin. This composite tissue provides all that is necessary for reconstruction of full-thickness defects of the ala and columella. Composite grafts are frequently used to repair defects of the nasal ala (1, 2, 3, 4). Although technically relatively easy to perform, they are limited by problems with viability, dimension, and atrophy. A free-tissue transfer harvested from the ascending helix can be used to repair defects of the distal part of the nose, including nasal sill, ala, tip, and columella (5, 6, 7).

INDICATIONS

Patients with full-thickness defects of the nasal tip, sill, ala, and columella, which would yield suboptimal results with a composite graft, should be considered for the procedure. Selection should include those patients with major concerns about further scarring of the midface or forehead. In addition, those who have undergone reconstructive attempts with more conventional techniques that have failed, are candidates for this procedure. Advantages of this flap include possible modifications of flap dimensions and orientation, to allow replacement of any portion of the distal hemi-nose. The flap is supplied by branches arising from the superficial temporal vascular pedicle, making microvascular transfer technically feasible. The size of the flap is limited only by the resulting donor deformity.

ANATOMY

Only gold members can continue reading. Log In or Register to continue