Repair of full-thickness alar defects

Tumor excision in the nasal ala can lead to full-thickness defects that require complex reconstruction. Prior research has shown that standard skin grafts may not provide sufficient structural support or aesthetic outcomes in such cases. No prior work had resolved the optimal combination of graft and flap techniques for nasal ala repair. This gap motivated the exploration of composite grafts paired with local flaps. The nasal ala's unique anatomy poses challenges for reconstruction due to its cartilage involvement and visibility. Existing methods may fail to restore symmetry or skin tone consistency. The need for a reliable, color-matching, and shape-preserving repair remains unmet in clinical practice. This study aimed to address that need with a novel combined approach.

The study aimed to evaluate a combined reconstructive method for full-thickness nasal ala defects caused by basal cell carcinoma. The specific problem addressed is the difficulty in restoring both structural integrity and aesthetic appearance after tumor removal. The motivation stems from the limitations of isolated grafts or flaps in this anatomical region. The method combines an auricular composite graft with a nasolabial flap to achieve better outcomes. The goal was to determine if this combination could reliably restore shape, color, and symmetry. The study sought to avoid complications like flap necrosis or blistering. It also aimed to ensure skin tone consistency with surrounding tissue. The approach was tested in patients with defects up to 2.0 × 2.5 cm² in size.

The study involved 11 patients with full-thickness nasal ala defects caused by basal cell carcinoma. Tumor removal left defects ranging from 1.5 × 2.0 to 2.0 × 2.5 cm². Composite grafts were harvested from the helix of the ear, measuring 1.5 × 1.5 to 1.5 × 2.0 cm². These grafts provided structural support for the defect site. A nasolabial flap was used to cover the cartilage of the composite graft. The flap was chosen for its color match and anatomical proximity. The graft and flap were combined to reconstruct the nasal ala. Postoperative outcomes were assessed for complications like necrosis or blistering. The study focused on symmetry, skin tone, and flap stability as primary endpoints.

All 11 patients were successfully treated with the combined graft-flap approach. No cases of flap necrosis, blistering, or skin color changes were observed. The reconstructed nasal ala maintained a stable shape and matched the surrounding skin tone. Symmetry was achieved in all cases, with no reported deformities. The composite graft provided sufficient structural support for the defect. The nasolabial flap covered the cartilage effectively and integrated well. The method was effective for defects up to 2.0 × 2.5 cm² in size. The results suggest that this combined technique offers reliable aesthetic and functional outcomes.

The authors proposed that combining an auricular composite graft with a nasolabial flap is a viable solution for full-thickness nasal ala defects. The method supports structural integrity and aesthetic outcomes. The study demonstrated that this approach avoids complications like necrosis or color mismatch. The reconstructed ala maintained symmetry and skin tone consistency. The composite graft served as a reliable scaffold for reconstruction. The nasolabial flap provided coverage and color match. The method was effective for defects up to 2.0 × 2.5 cm² in size. The authors suggest that this combined technique may be a preferred option in similar clinical scenarios.