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 © January 2012
Omar A. Ibrahimi MD PhD,a,b Tracy Campbell MD,c Summer Youker MD,d Daniel B. Eisen MD,e
aUniversity of Connecticut, Department of Dermatology, Farmington, CT bWellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA cPrivate practice, Chicago, IL dPrivate practice, Sacramento, CA eUniversity of California Davis, Department of Dermatology, Sacramento, CA
Abstract
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.
INTRODUCTION
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
