The "drumhead" graft repair of deep nasal alar defects

Extirpation of tumors on the perialar region often results in deep surgical defects. The nares and internal nasal valves are supported not just by alar cartilage, but also by the suspension effect of the overlying skin and subcutaneous tissue. Surgical loss of tissue may result in inward collapse of the nasal vestibule with resultant difficulty in breathing. The use of full-thickness skin grafts (FTSGs) on deep alar defects commonly results in a sunken or depressed graft that is functionally and cosmetically unacceptable.

We describe a novel technique that enables the use of FTSGs in the repair of deep nasal alar defects through the application of an overlying, rigid plastic suspension strut coupled with an undersized graft.

The drumhead FTSG is effective in preventing collapse of the nasal vestibule as well as undesirable contour irregularities due to a depressed or sunken graft. Patients were seen at 1 week, 4 weeks, and 3 months postoperatively. At each time point, there was no nasal vestibular collapse and only very slight graft depression, which replicated the normal mild concavity of the alar crease region. All patients had excellent functional and cosmetic outcomes. No adverse effects were noted.

The "drumhead" graft is a novel technique, which enables the use of FTSGs for deep alar defects by inhibiting undesirable depression of the graft and preventing collapse of the nasal vestibule.