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Nasal Reconstruction with
Composite
Chondrocutaneous Grafts
Dr Sumer Yadav
Plastic surgery
Composite Graft
Described by Konig 1887
Phase I Cut Graft Dead White
Phase II 6 Hours Post-op Pale Pink
Phase III 12 – ...
AUTHORAUTHOR YEARYEAR # of# of
GraftsGrafts
PARTIALPARTIAL
FAILUREFAILURE
TOTALTOTAL
FAILURESFAILURES
KonigKonig 19141914 ...
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
Cartilage Sheet Acts as a Barrier
to Revascularization
Turn-Down Flap for Nasal Lining
Provides Large Surface Area for Gra...
The Ideal Donor Site:
Anterior Crus of Helix & Pretragal Skin
Most Closely
Resembles
Nasal Ala In:
Contour
Thickness
Size
Texture
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 ...
Etiology of Defect
Technical Changes
Over 20 Years
Skin Cancer 478
Trauma 16
Rhombergs 3
Hemangiomas 2
Congenital Nev...
Success Depends Upon: Essentials for Success
Optimal Recipient Bed
Graft Size
Atraumatic Handling of Graft
? Cooling
...
Disadvantages
of Flaps
Advantages of
Composite Grafts
Tendency Toward Chronic Edema
Lack of Aesthetic Definition of Ala
...
5% Revisions on
Patients
With Complete Take
»Thnx
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  1. 1. Nasal Reconstruction with Composite Chondrocutaneous Grafts Dr Sumer Yadav Plastic surgery
  2. 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. 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. 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
  5. 5. Cartilage Sheet Acts as a Barrier to Revascularization Turn-Down Flap for Nasal Lining Provides Large Surface Area for Graft Revascularization
  6. 6. The Ideal Donor Site: Anterior Crus of Helix & Pretragal Skin
  7. 7. Most Closely Resembles Nasal Ala In: Contour Thickness Size Texture Color
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 5% Revisions on Patients With Complete Take
  13. 13. »Thnx
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