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

Abstract

AbstractThe columella is unique as a nasal subunit. The nasal columella has traditionally been a difficult subunit to repair because of its unique contours, tenuous vascularity, and limited availability of adjacent skin. Columellar defects can significantly impair aesthetic appearance. Columellar damage can be caused by congenital loss, ischemic injuries, trauma, tumor resection, and vascular malformations. Columella reconstruction can be very challenging for plastic surgeons.Defects of the nasal columella can be repaired using various methods including composite free grafts from the ear (1,2), nasolabial flaps (3), nasofacial sulcus flaps (4), forehead flaps (5), extended Abbe flaps (6), and free flaps (7).Auricular chondrocutaneous composite grafts have been reported in the literature. The main advantages of these grafts are avoidance of facial scars and provision of tip support. However, risk of composite graft loss was reported as a main complication.Herein, we report two cases of columellar defect reconstructions in children using a custom-made columella from conchal composite graft with the tongue-in-groove principle. The main advantage of this technique is that it is one-stage method; the custom-made columella depends on the dimensions of the defect, so it can be tailored according to the dimension of the columellar defect; the use of the tongue-in-groove principle increases the contact surface between the graft and recipient. Therefore, increase the possibility of survival of the reconstructed columella with minimal donor site morbidity.