Nonanatomic Free Cartilage Batten Grafting With Second Intention Healing for Defects on the Distal Nose
January 2012 | Volume 11 | Issue 1 | Original Article | 46 | Copyright © 2012
Background: Defects of the distal nose, particularly the nasal ala, pose a reconstructive challenge due to the lack of loose adjacent tissue and proximity to a free margin.
Objective: We report our experience using nonanatomic free cartilage batten grafts in combination with second intention healing for nasal ala defects.
Methods: A retrospective study of distal nose defects repaired using nonanatomic free cartilage batten grafting with second intention healing was performed. Detailed data on the quality of the scar, post-operative complications, free margin distortion, functional impairments, and patient satisfaction were recorded. Digital images were also shown to an experienced fellowship-trained Mohs surgeon to assess the overall aesthetic outcome using a 5-point score ranging from poor to excellent.
Results: Sixteen subjects were included in the study. Complications were common, but minor. Five (~31%) subjects had subtle contour depressions, three (~18%) subjects had excessive granulation tissue, two (~12%) subjects had post-operative ear pain at the donor site lasting up to 10 days, and one (~6%) subject had a hypertrophic scar at the recipient site. There were two occurrences (~12%) of mild alar notching but no occurrences of significant alar margin distortion or nasal valve dysfunction. In terms of aesthetic outcome, seven (~43%) were assessed by an independent fellowship-trained Mohs surgeon as having excellent aesthetic outcomes, six (~38%) were very good, and three (~19%) were good. All sixteen subjects reported satisfaction on follow-up evaluation.
Conclusions: Nonanatomic free cartilage grafting with second intention healing allows for facile, single-step repair of nasal ala defects with high patient satisfaction and aesthetically pleasing results. This provides an attractive alternative to other flap techniques, skin grafting, and healing via secondary intention.
J Drugs Dermatol. 2012;11(1):46-50.
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The nose is a common location for cutaneous malignancies. Defects of the distal nose, particularly the nasal ala, pose a reconstructive conundrum due to the dearth of loose adjacent tissue and proximity to a free margin. A variety of reconstructive options have been proposed for repair of defects involving the nasal ala.1-2 The use of nonanatomic free cartilage batten grafting in combination with second intention healing has been recently reported for nasal ala defects.3-4 Here, we report the results of a retrospective case series analyzing the use of nonanatomic free cartilage grafts in combination with second intention healing for defects of the distal nose.
MATERIALS & METHODS
Seventeen distal nose defects resulting from Mohs micrographic surgery were repaired using free cartilage grafting with second intention healing over the one-year study period. The grafts were performed by a single attending surgeon (DBE) and one of two procedural dermatology fellows (OAI and TC). The procedure was done as described: a rectangular skin flap at least the same size as the nasal defect was elevated in the area of the conchal bowl or antihelix to expose the auricular cartilage. A cartilage batten graft was harvested from the conchal bowl or antihelix that measured the defect length plus 6 mm and a similar size to the defect height. Attention was given to preserving the perichondrium during harvesting of the graft. The graft site was immediately repaired with a single layer closure using 4-0 chromic gut, while the graft was placed in a cup of sterile normal saline. Two subcutaneous pockets were then created on lateral edges of the distal nasal defect into which the cartilage batten graft was stabilized. 4-0 chromic gut, which was placed prior to the implantation of the cartilage batten graft, was then tied over to secure the cartilage graft in the wound bed. Petrolatum and