Utilizing Auricular Composite Grafts for Reconstruction of Nasal Ala Defects in Fitzpatrick Type III-V Indian Noses: Techniques and Outcomes.
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BACKGROUND: Nasal ala defects present significant reconstructive challenges due to their complex anatomy and functional importance. Auricular composite grafts, incorporating both skin and cartilage, are particularly suited for this purpose because they can replace the multilayered structure of the nasal ala in a single surgical procedure, thereby restoring both form and function. Clinical outcomes of these grafts in the reconstruction of ala defects have been highly promising with studies indicating near complete survival rates. These findings underscore the efficacy of composite grafts in achieving successful results in these small but difficult defects to manage. OBJECTIVE: The primary objective of this study is to assess the use of composite graft in Fitzpatrick type III-V Indian noses from survival and esthetic point of view. MATERIALS AND METHODS: A retrospective review was conducted on eleven patients who underwent nasal ala reconstruction using auricular composite grafts between 2012 and 2022. Data collected included patient demographics, defect etiology and characteristics, surgical technique, postoperative outcomes and complications and follow-up duration. RESULTS: A total of eleven patients, age ranged from 17 to 68 years, were included in the study. The majority of defects (seven) were acquired and resulted from trauma, ring avulsion and tumor excision and four were congenital clefts of ala. Graft survival rate was more than 90% with a follow-up period of 6 months to 2 years. Out of eleven grafts, one shrank approximately to half. No other complication was noted. Rest ten graft survived well with minimal shrinkage and produced esthetically pleasing and good functional outcome. CONCLUSIONS: Auricular composite grafts are a reliable and effective option for nasal ala reconstruction. The technique demonstrates a favorable balance between functional restoration and cosmetic appearance, with an acceptable complication rate. Careful selection of patients, suitable conditions and an additional vascular bed provided by turndown flap of lining allow a better survival of not only of standard size grafts but even slightly bigger grafts. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .