Columella lengthening by a vascularized preauricular flap

Short columella can lead to both cosmetic and functional issues. Current methods like local flap transfer and composite grafts have limitations. Local flaps lack new tissue, and composite grafts face viability and atrophy challenges. Preauricular tissue offers good color and texture, but lacks stable blood supply. This gap motivated the development of a vascularized flap approach. Prior research has shown that graft survival is a major concern in columellar reconstruction. No prior work had resolved the issue of consistent blood supply for composite grafts. This paper introduces a new method using vascularized preauricular flaps. The study aims to improve outcomes in patients with short columellas.

The goal is to evaluate a vascularized preauricular flap for columellar lengthening. The authors aim to address the limitations of existing techniques. They propose using a free flap based on superficial temporal vessels. This method is intended to provide stable blood supply and tissue volume. The study focuses on patients with short columellas who have not responded well to prior methods. The authors seek to demonstrate flap survival and aesthetic outcomes. They also aim to assess the need for secondary procedures. The study is motivated by the need for reliable and functional reconstruction.

The vascularized preauricular flap was based on superficial temporal vessels. Flaps were harvested as free flaps and transferred to the columella region. Recipient vessels included angular or facial vessels. Microsurgical anastomosis was performed between the flap and recipient vessels. Vascular grafts from lateral femoral circumflex vessels were used when needed. Six flaps were harvested in reverse fashion, and two in anterograde direction. Flap survival and aesthetic outcomes were evaluated in eight patients. Postoperative follow-up included assessment of color, texture, and scar formation.

Eight patients with short columellas underwent reconstruction with vascularized preauricular flaps. All flaps survived well with good color and texture match. An average of 13.3 mm improvement in length was achieved. No major complications were reported in the initial postoperative period. Two patients required secondary debulking procedures to thin the flap. Flap harvesting was performed in both reverse and anterograde directions. Microsurgical anastomosis was successful in all cases. The authors report no hypertrophic scarring in any patient.

The vascularized preauricular flap is a reliable method for columellar lengthening. The authors report successful flap survival and aesthetic outcomes. The method provides stable blood supply and tissue volume. The preauricular region offers excellent color and texture match. The study supports the clinical application of this technique. The authors suggest that this method is superior to prior approaches. No prior work had demonstrated consistent outcomes with this flap design. The authors conclude that this technique has wide clinical utility.