Case Reports of an Innovative Technique for Columellar Reconstruction in Children Using a Custom-Made Composite Graft from the Back of the Ear

Abstract

The columella is unique as a nasal subunit. The nasalcolumella has traditionally been a difficult subunit to repairbecause of its unique contours, tenuous vascularity, and limitedavailability of adjacent skin. Columellar defects can significantlyimpair aesthetic appearance. Columellar damage canbe caused by congenital loss, ischemic injuries, trauma, tumorresection, and vascular malformations. Columella reconstructioncan be very challenging for plastic surgeons.Defects of the nasal columella can be repaired usingvarious methods including composite free grafts from the ear(1,2), nasolabial flaps (3), nasofacial sulcus flaps (4), foreheadflaps (5), extended Abbe flaps (6), and free flaps (7).Auricular chondrocutaneous composite grafts have beenreported in the literature. The main advantage of these graftsare avoidance of facial scars and provision of tip support.However, risk of composite graft loss was reported as a maincomplication.Herein, we report two cases of columellar defect reconstructionsin children using a custom-made columella froma conchal composite graft with the tongue-in-groove principle.The main advantages of this technique are that it is a onestagemethod; the custom-made columella depends on thedimensions of the defect, so it can be tailored according tothe dimension of the columellar defect; the use of the tonguein-groove principle increases the contact surface between thegraft and recipient, therefore, increase the possibility ofsurvival of the reconstructed columella; with minimal donorsite morbidity.