Nasal Reconstruction With Mid-helical Rim Composite Grafts: A Single Surgeon's Experience Based on 65 Cases

The use of composite grafts for reconstruction of nasal defects involving the alar rim has long been established. The standard donor site is the root of the helix, which limits the size of the graft and can distort the upper pole of the ear. An alternative approach using the mid-helical rim, by contrast, allows a larger graft size to be harvested and eliminates the need for additional flap closure of the donor site. We detail our 1-stage technique and outcomes of using a mid-helical rim composite graft for nasal defects involving the alar rim.

This retrospective cohort outlines a single surgeon's use of the mid-helical rim composite graft for reconstruction of full-thickness nasal alar defects.

A total of 65 patients underwent the mid-helical rim composite graft procedure from 2010 to 2024. The procedure was performed under local anesthetic with intravenous sedation in 63 (97%) patients following excision of a basal cell carcinoma. The median defect size along the alar rim was 14 mm (range, 9-20 mm), as measured by the pathologist following formalin fixation. The excision of the tumor and the reconstruction were performed in a single procedure. Four grafts were lost, with 3 losses occurring in patients with a history of smoking.

The mid-helical rim composite graft can be used for 1-stage reconstruction of nasal defects involving up to 20 mm of the alar rim, with reliable outcomes. Graft take is improved by creating a defect that increases the size of the recipient vascular bed.