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The Navicular Graft for Reconstructing Deep Alar Defects.

Caitlin Robinson1, Nader Aboul-Fettouh2, Timothy Hansen3

  • 1Dermatology, Colorado Springs Dermatology Clinic, Colorado Springs, USA.

Cureus
|August 31, 2021
PubMed
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This article introduces a new method for repairing deep nasal ala defects using a specially shaped skin graft. Traditional grafts often lead to scarring and poor contour restoration. The navicular graft is sculpted into a boat-like shape to restore volume and maintain the natural contour of the ala. This technique avoids the need for more complex procedures involving cartilage or flaps. The graft matches the skin’s texture and color, reducing visible scarring. No additional supports like struts are needed. The results suggest this method offers good functional and aesthetic outcomes.

Area of Science:

  • Plastic and Reconstructive Surgery
  • Dermatologic Surgery
  • Facial Reconstruction Techniques

Background:

Reconstructing defects in the deep nasal ala remains a clinical challenge. The skin in this region is thick and sebaceous, providing structural support that maintains the shape of the ala and nasal patency. When this tissue is lost, deformities can occur, including alar collapse and nasal vestibule instability. Traditional full-thickness skin grafts have been used, but they often lead to depressed scars. Prior research has shown that these grafts may not fully restore volume or maintain a natural contour. This gap motivated the development of alternative grafting techniques. No prior work had resolved the issue of achieving both volume and contour with minimal scarring. The need for a more effective solution is clear. This paper addresses that need through a novel graft design.

Purpose Of The Study:

This study aims to introduce a modified full-thickness skin graft technique for deep nasal ala defects. The specific problem addressed is the limitation of traditional grafts in restoring volume and contour while avoiding depressed scarring. The motivation stems from the need for a less invasive alternative to cartilage grafts or flaps. The proposed solution is a navicular-shaped graft that mimics the natural contour of the ala. This approach is intended to avoid extensive procedures and reduce postoperative complications. The design is based on the structural properties of the alar skin. The goal is to provide a graft that matches both texture and color while preserving nasal function. This method is proposed as a simpler alternative to more complex reconstructive techniques.

Keywords:
full-thickness skin graftmohs surgerynasal alareconstructionskin cancerskin graftnasal ala reconstructionnavicular graft techniquefull-thickness skin graftfacial reconstructive surgery

Frequently Asked Questions

The navicular graft is shaped to mimic the natural contour of the ala, restoring volume and preventing collapse without extensive procedures.

Full-thickness skin grafts avoid the need for cartilage or flaps, reducing surgical complexity and recovery time.

The boat-shaped design allows for volume restoration and contour matching, avoiding pitting or retraction.

The graft’s shape and volume provide structural support, eliminating the need for additional stabilizing devices.

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Main Methods:

The study introduces a variation of the full-thickness skin graft tailored for deep alar defects. The graft is sculpted into a boat-shaped or navicular form to restore volume and contour. This technique avoids the use of cartilage grafts or flaps. The graft is harvested from a donor site with similar texture and color to the alar region. The shape is designed to fit the curvature of the nasal ala. No struts or bolsters are used during placement. The graft is positioned to maintain structural support and prevent retraction. The method is described in detail to ensure reproducibility and standardization.

Main Results:

The navicular graft successfully restored volume and contour in deep alar defects. No cases of pitting, notching, or retraction were observed postoperatively. The graft provided a natural color and texture match to surrounding tissues. The absence of struts or bolsters simplified the procedure. Patients experienced minimal scarring compared to traditional grafts. The technique avoided the need for more extensive procedures involving cartilage or flaps. Outcomes demonstrated good cosmesis and nasal patency. The results suggest this graft is a viable alternative to conventional methods.

Conclusions:

The authors conclude that the navicular graft is a suitable option for reconstructing deep alar defects. The technique avoids extensive procedures and provides good functional and aesthetic outcomes. The graft’s shape allows for volume restoration and contour preservation. No additional structural supports are required. The results suggest this method is effective in preventing alar collapse. The graft’s texture and color match reduces visible scarring. The authors propose that this technique may be preferred over traditional full-thickness grafts. The findings suggest this approach may improve patient outcomes in nasal reconstruction.

Patients experienced minimal scarring and no pitting, notching, or retraction of nasal structures.

The authors suggest the navicular graft may be a preferred alternative to traditional grafting techniques.