Nasal Reconstruction with Composite

Chondrocutaneous Grafts

Dr Sumer YadavPlastic surgery

Composite Graft Described by Konig 1887

Phase I Cut Graft Dead WhitePhase II 6 Hours Post-op Pale PinkPhase III 12 – 24 Hours Post-op Deep

“Cyanosis”Phase IV 3 – 6 Days Graft Acquires Healthy

Color

The Wider the Surface Contact, the More Rapid the Revascularization

AUTHORAUTHOR YEARYEAR # of # of GraftsGrafts

PARTIAL PARTIAL FAILUREFAILURE

TOTAL TOTAL FAILURESFAILURES

KonigKonig 19141914 4747 22 (47%)22 (47%)

LimbergLimberg 19351935 4747 6 (12%)6 (12%)Brown & Brown & CannonCannon 19461946 5050 4 (8%)4 (8%)Symonds & Symonds & GrikelairGrikelair 19561956 3636 22 2 (11%)2 (11%)

ConleyConley 19561956 1212 2 (16%)2 (16%)Davenport & Davenport & BernardBernard 19591959 1717 33

Rees et alRees et al 19631963 3535 22Dufourmental & Dufourmental & PesteurPesteur 19731973 4343 4 (9%)4 (9%)

A 2cm Composite Graft has a 90 - 95% Survival Rate

No Part of the Composite Graft ShouldBe More than 1cm from a Free Edge

Cartilage Sheet Acts as a Barrier to Revascularization

Turn-Down Flap for Nasal LiningProvides Large Surface Area for Graft

Revascularization

The Ideal Donor Site:Anterior Crus of Helix & Pretragal Skin

Most Closely Resembles

Nasal Ala In:

ContourThicknessSizeTexture Color

Width Number Complete Take Partial Loss Major Loss(Less than 20%) (None Complete)

>2.5cm 61 54 (89%) 1 6

1.5 – 2.5cm 342 318 (93%) 7 17

<1.5cm 97 93 (96%) 3 1

500 Composite Grafts 1979 - 2000

Etiology of Defect Technical Changes Over 20 Years

Skin Cancer 478Trauma 16Rhombergs 3Hemangiomas 2Congenital Nevus 1

Use of Contralateral EarTongue in Groove Alar RimNo Primary Grafts – Allow for complete

Healing , at Least 3 Months6-0 Monocryl Dermal Sutures to

Recipient Bed to Eliminate Dead Space

Success Depends Upon: Essentials for Success

Optimal Recipient BedGraft SizeAtraumatic Handling of Graft? Cooling

Well Vascularized Turn-down FlapAtraumatic Tissue HandlingCool the Graft for 72 HoursStrict patient Cooperation

No Smoking No Chewing Minimal Talking

Disadvantagesof Flaps

Advantages of Composite Grafts

Tendency Toward Chronic EdemaLack of Aesthetic Definition of AlaOften Requires RevisionOccasional Unsightly Donor Site

ScarUsually Require Several Stages

One Stage OperationSuperior Donor SitePatient ComfortSuperior Aesthetic ResultDoes Not Preclude Flaps

5% Revisions on Patients

With Complete Take

»Thnx