Chondrocutaneous composite grafts are a viable option for nasal alar defects larger than 1.5 cm

Nasal reconstructions are one of the most commonly performed plastic surgery procedures. The complex anatomy and critical functionality of the nose demand precise surgical approaches and planning. This is especially pertinent for subunits such as the ala. Chondrocutaneous composite grafts from the ear are excellent options for alar reconstruction, but are limited to a maximum diameter of 1.5 cm, according to historic guidelines. This study compared complication rates associated with composite grafts that are greater and smaller than the reported size limit.

A retrospective review was conducted for 53 patients who received auricular composite grafts for alar repair following Mohs micrographic surgery. Complications, including graft loss, infection, postoperative bleeding, hematoma, and functional deficits, were noted. Additionally, patients who received esthetic revisions were observed.

Thirty-two grafts were <1.5 cm in diameter, and 21 were >1.5 cm in diameter. One patient had a postoperative complication, and 7 received esthetic revisional procedures. There were no significant size-dependent differences in complication rates (p = 0.396). There was a significant difference in esthetic revision rates between grafts greater than and smaller than 1.5 cm in diameter.

We present the first study examining the validity of using 1.5 cm as the upper diameter bound for composite grafts. Our results indicate that composite grafts are safe and effective for reconstruction of nasal ala defects >1.5 cm. These larger grafts may benefit from minor esthetic adjustments once they have healed.