The chondrocutaneous ear helical free flap for the reconstruction of the defects of the nasal tip, columella and/or ala

Abstract

Reconstruction of the full-thickness defect of the tip of nose, columella, and ala has always been a challenge. Local flaps can be used, but this often results in a bulky nose with an unsatisfactory aesthetic appearance requiring secondary surgical procedures. The use of the ear as a donor site for a microvascular free flap, although not general consensus despite structural similarities between the nose and ear, offers a possibility of a good reconstruction for such patients. Five patients presented with composite tissue defects of the tip, columella and ala of the nose resulting from human bites. Reconstruction was performed early in order to avoid possible infection. The free flap was designed and elevated from the upper part of the helix and concha of the opposite ear; the flap matched the traumatic defect on the nose and was based on the anterior auricular branches of the superficial temporal vessels. The free flap was brought to the defect and sutured to the margins. Direct end-to-end anastomosis of both vessels was performed in four patients while a venous grafts was needed in one patient. The donor flap area was closed directly. The follow-up period ranged from six months to five years. The reconstruction was satisfactory as to contour, symmetry and colour match in four patients. The final aesthetic result was obtained by touch-up procedures under local anesthesia. The donor site deformity was minimal. In one patient, the free flap was lost due to venous thrombosis and late reintervention. The chondrocutaneous free flap represents a dependable vascularized composite tissue transfer that offers a straightforward one-stage reconstruction of tissue defects of the tip, columella, and ala of the nose. The additional advantages of freedom in the flap design and structural similarity between the nose and ear makes it an ideal choice for such defects.