nasal reconstruction

1. Nasal Reconstruction with
Composite
Chondrocutaneous Grafts
Dr Sumer Yadav
Plastic surgery

2. Composite Graft
Described by Konig 1887
Phase I Cut Graft Dead White
Phase II 6 Hours Post-op Pale Pink
Phase 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

3. AUTHORAUTHOR YEARYEAR # of# of
GraftsGrafts
PARTIALPARTIAL
FAILUREFAILURE
TOTALTOTAL
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 22
Dufourmental &Dufourmental &
PesteurPesteur
19731973 4343 4 (9%)4 (9%)

4. A 2cm Composite Graft has a
90 - 95% Survival Rate
No Part of the Composite Graft Should
Be More than 1cm from a Free Edge

16. Cartilage Sheet Acts as a Barrier
to Revascularization
Turn-Down Flap for Nasal Lining
Provides Large Surface Area for Graft
Revascularization

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

18. Most Closely
Resembles
Nasal Ala In:
Contour
Thickness
Size
Texture
Color

68. 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

69. Etiology of Defect
Technical Changes
Over 20 Years
Skin Cancer 478
Trauma 16
Rhombergs 3
Hemangiomas 2
Congenital Nevus 1
Use of Contralateral Ear
Tongue in Groove Alar Rim
No Primary Grafts – Allow for complete
Healing , at Least 3 Months
6-0 Monocryl Dermal Sutures to
Recipient Bed to Eliminate Dead Space

70. Success Depends Upon: Essentials for Success
Optimal Recipient Bed
Graft Size
Atraumatic Handling of Graft
? Cooling
Well Vascularized Turn-down Flap
Atraumatic Tissue Handling
Cool the Graft for 72 Hours
Strict patient Cooperation
 No Smoking
 No Chewing
 Minimal Talking

71. Disadvantages
of Flaps
Advantages of
Composite Grafts
Tendency Toward Chronic Edema
Lack of Aesthetic Definition of Ala
Often Requires Revision
Occasional Unsightly Donor Site
Scar
Usually Require Several Stages
One Stage Operation
Superior Donor Site
Patient Comfort
Superior Aesthetic Result
Does Not Preclude Flaps

72. 5% Revisions on
Patients
With Complete Take

73. »Thnx