Outcomes of the three-layer technique of nasal alar defect repair

Abstract

Background Nasal defects are usually defined as 'partial' or 'full' thickness. The main role of reconstructive surgery is replacement of the defective tissues with nearly similar tissues. Design This study was a retrospective case series with chart review. The study was conducted at academic tertiary care medical centers. The aim of this study was to evaluate a three-layer reconstruction (functional and esthetic evaluation). Patients and methods Nine patients presented to our office with a defect in the lower third of the nose after an accident or secondary to nasal lesion removal. In our technique, we described a single-stage, three-layer reconstruction. This technique was used to repair the full thickness alar and lower lateral cartilage defects. We designed the new three-layer repair based on the normal anatomy and histology using bilobed skin flap and lateral nasal wall mucosal rotational flaps with septal cartilage graft. Results Aesthetically acceptable results were obtained without the compromise of the nasal valve function, which was assessed using acoustic rhinometry. The acoustic rhinometric evaluation for the nasal valve (1.5–2 cm from the nostril) function showed that the cross-sectional area on the repaired side was 0.46–0.78 cm2 and it was 0.52–0.81 cm2 on the other site (P = 0.670), with a normal nasal cycle and without compromising the airway. Moreover, minimal donor site morbidity was observed. Conclusion The bilobed skin flap and rotational mucosal flap with septal cartilage graft for full thickness alar defect, is a novel technique with minimal donor site morbidity, acceptable postoperative shape and good functional results.