Faculty Bibliography

The nasal ala and helical rim of the ear are common sites for the development of skin neoplasms. Removal of skin cancers from these aesthetically delicate areas may leave defects that free skin grafts alone may not adequately repair. The contractural forces of scarring within and around the skin graft during healing may produce elevation or notching of the rim and may lead to functional compromise. The use of a composite graft or the inclusion of a free cartilage graft in conjunction with a skin graft or flap repair can provide structural support, which may help to prevent undesirable outcomes. This article focuses on the use of composite or free cartilage grafts harvested from the ear to repair nasal alar or helical rim defects within a single surgical session. Preoperative considerations, surgical technique, and postsurgical complications are discussed.

BACKGROUND:Full-thickness defects of the alar rim can be challenging to repair and often require the use of multistaged interpolated flaps. Alar notching is a known complication of these procedures even after cartilage batten grafts have been placed to support the alar framework. Standard techniques for repair of alar notching involve reinsertion of a cartilage graft, usually at the time of alar groove reconstruction 3 months postoperatively. OBJECTIVE:We present a technique to prevent alar notching associated with nasolabial interpolation flaps. If early notching is noted at the time of pedicle division, preemptive placement of a skin-fat composite graft can obviate the need for additional procedures. METHODS:A case report detailing the procedure and a review of the options for repair of alar notching are provided. RESULTS. Placement of a skin-fat composite graft harvested from the divided pedicle flap resulted in correction of alar notching. CONCLUSION/CONCLUSIONS:This procedure is presented as an alternative to delayed cartilage grafting for repair of alar rim notching after placement of an interpolated pedicle flap. If notching is noted early, correction at the time of pedicle division allows for use of available tissue for composite grafting, avoidance of a delayed reconstructive procedure, and a good functional and cosmetic

BACKGROUND:There are several options for closure of a given surgical defect after tumor extirpation is confirmed. Flap reconstruction is one of these options. OBJECTIVE:The purpose of this article is to introduce the three basic types of flap movement: advancement, rotation, and transposition. METHODS:Five similar defects located on the nasal sidewall were repaired, each using a different flap design. RESULTS:The optimal flap design for a given defect on a particular patient is based on the answers to a series of questions: Where is the available tissue reservoir? How can tissue be mobilized from the reservoir to cover the defect? How do the resulting tension vectors affect critical structures? Where are the final incision lines? CONCLUSION/CONCLUSIONS:Many factors must be evaluated before determining a method of reconstruction. Flap reconstruction requires a thorough understanding of anatomy and tissue movement.