Auricular Composite Graft Research Articles

Use of Auricular Composite graft in Rib-Cartilage based Rhinoplasty for Contracted Nose Correction.

This study investigated the effects of combining an auricular composite graft with rib cartilage-based rhinoplasty to correct contracted noses in Asian patients with a history of multiple previous operations. A total of 43 patients were included in the retrospective analysis of secondary rhinoplasty procedures. The surgical approach involved short-nose correction, utilizing rib cartilage for septal extension grafts and chondrocutaneous composite grafts harvested from the conchal part of the ear for internal nasal lining reconstruction. Our assessment encompassed clinical outcomes, the occurrence of complications, and the utilization of three-dimensional (3D) photography for nasal measurements at the preoperative, 3-month, and 1-year postoperative stages. Regarding graft survival, 12 (27.9%) patients showed >80% graft engraftment, followed by 29 (67.4%) patients with 50%-80% graft engraftment, and 2 (4.6%) patients with 20%-50% graft engraftment. Two of these patients required wound irrigation for infection control and additional repair and were finally discharged without significant nasal deformity. At 3 months postoperatively, 3D anthropometry showed significant differences in nasal dorsum length (4.46 ± 1.79 mm), nasal height (1.25 ± 1.25 mm), nasal tip projection (4.06 ± 1.76 mm), and columellar-labial angle (22.75° ± 14.19°). No significant relapse of nasal parameters was noted 1 year postoperatively. Auricular composite graft combined with rib cartilage-based rhinoplasty enables the comprehensive restoration of nasal structures, addressing the inner, intermediate, and outer layers. This approach can serve as an effective and sustainable option for correcting contracted noses in Asian patients who have undergone multiple operations.

Classification and reconstructive algorithm for nasal alar defect in Asians

BackgroundThe nasal alar defect in Asians remains a challenging issue, as do clear classification and algorithm guidance, despite numerous previously described surgical techniques. The aim of this study is to propose a surgical algorithm that addresses the appropriate surgical procedures for different types of nasal alar defects in Asian patients. MethodsA retrospective case note review was conducted on 32 patients with nasal alar defect who underwent reconstruction between 2008 and 2022. Based on careful analysis and our clinical experience, we proposed a classification system for nasal alar defects and presented a reconstructive algorithm. Patient data, including age, sex, diagnosis, surgical options, and complications, were assessed. The extent of surgical scar formation was evaluated using standard photography based on a 4-grade scar scale. ResultsAmong the 32 patients, there were 20 males and 12 females with nasal alar defects. The predominant cause of trauma in China was industrial factors. The majority of alar defects were classified as type I C (n=8, 25%), comprising 18 cases (56.2%); there were 5 cases (15.6%) of type II defect, 7 (21.9%) of type III defect, and 2 (6.3%) of type IV defect. The most common surgical option was auricular composite graft (n=8, 25%), followed by bilobed flap (n=6, 18.8%), free auricular composite flap (n=4, 12.5%), and primary closure (n=3, 9.4%). Satisfactory improvements were observed postoperatively. ConclusionFactors contributing to classifications were analyzed and defined, providing a framework for the proposed classification system. The reconstructive algorithm offers surgeons appropriate procedures for treating nasal alar defect in Asians.

The Effects of Radial Cartilage Incision on the Growth of Rabbit Ear.

Recently, radial cartilage incision (first-stage) at an early age combined with free auricular composite tissue grafting (second-stage) can effectively correct the concha-type microtia with the moderate or severe folded cartilage in the middle and upper third auricle, but radial cartilage incision's effects on the growth of the ear remain to be determined. The authors aimed to evaluate the effects of radial cartilage incision in young rabbits model. Ten New Zealand white rabbits were included in our experiment. Two ears of each rabbit were divided randomly into two groups. The experimental group was operated with radial cartilage incision, and no intervention was given to the control group. The ear width, length, and perimeter were noted every two weeks. Auricular surface area was noted at 4 and 22 weeks old. The repeated measures ANOVA was used to describe ears' growth trend. A paired-sample's t test is conducted to test whether there are significant differences among the variables through the SPSS25.0 software. The growth tendencies of the ear length, width, and perimeter were observed and analyzed. The growth curves of the experimental ears were similar to that of the control. There was no significant difference in the increased ratio of surface area among the two groups. The cartilage of the experimental ears showed no change in biomechanical properties compared to that of control group. This study shows that radial cartilage incision at an early age does not influence the growth of rabbit ear length, width, perimeter, and surface area and also does not change the biomechanical properties of the cartilage. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Auricular Composite Graft Survival in Rhinoplasty.

Auricular composite grafts can be used in rhinoplasty to correct defects of the internal nasal valve, ala, vestibule, sill, and external nose. The objective of this study was to measure the auricular composite graft (ACG) survival rate and patient-reported outcome with Nasal Obstruction Symptom Evaluation (NOSE) score among patients undergoing rhinoplasty. A retrospective chart review was performed of all patients who underwent rhinoplasty with ACGs from 2002 to 2019 by the senior author. Median patient age was 42 years (range 14-79) with 80.3% being female. In total, 234 rhinoplasty procedures were performed utilizing 367 auricular composite grafts. Secondary rhinoplasty (n = 160, 68.4%) was the most common. And 93.7% of ACGs had full take. There were 23 partial or total graft failures, producing graft failure rate of 6.3%. Mean preoperative NOSE score was 24.08, and mean postoperative NOSE score was 21.84, with a p-value of 0.63. Auricular composite grafts can be used to repair a wide range of defects of the internal nasal valve, nasal sill-ala junction, nasal vestibule, and external nose.

Reconstruction of a severely gashed auricle using two-stage cartilage preservation surgery following auricular composite graft failure: a case report

After the failure of a composite graft in a patient with complete auricle amputation, we successfully reconstructed the severely gashed auricle using two-stage cartilage preservation surgery. We removed the skin of the amputee and buried the cartilage under the postauricular scalp. The end of the right ear was sutured to the postauricular scalp. A separation surgery was performed on the 14th day after the burying surgery. After removing the suture, the cartilage along with the postauricular scalp was carefully separated from the postauricular donor site under local anesthesia. Using two-stage cartilage preservation surgery, we successfully reconstructed the severely gashed auricle and achieved cosmetically and functionally satisfactory results.

Frostbite sequela treated by auricular composite graft

Introduction: Nasal defects following frostbite is not uncommon and need more complicated operations to reconstruct. Composite graft is an available and feasible treatment to replace nasal unit defects, though several factors influence transferred graft. Case presentation: A middle age mountain climber who had suffered nasal frostbite sequela as retracted right side alar rim, referred 28 months later to reconstruct. A triangular helical chondrocutaneous graft as composite graft selected to replace defects of inner layer, supporting cartilage and outer skin. After prolonged healing phase, he had satisfied with her nose. Conclusion: Composite grafts are save-boats in nasal reconstructions even, patient be a frostbite victum.

Component Restoration in the Bilateral Intermediate Cleft Tip Rhinoplasty.

The intermediate cleft tip rhinoplasty is frequently performed during childhood to address nasal tip anomalies in cleft patients before the most critical period of psychosocial development. The authors previously described the component restoration intermediate cleft tip rhinoplasty technique for the unilateral cleft nose, which was developed to systematically address the lining deficiency, cleft lower lateral cartilage malpositioning, and cleft lateral cartilage weakness using a combination of lower lateral cartilage release, lateral cartilage repositioning, and placement of an auricular composite chondrocutaneous graft. In this work, the authors evaluate the utility of this technique to the bilateral cleft nose. Preoperative and postoperative (mean ± SD, 18.6 ± 10.8 months) photographs of bilateral cleft patients treated with the component restoration intermediate cleft tip rhinoplasty (n = 7) were evaluated using photogrammetric measurements and aesthetic assessments. From preoperatively to postoperatively, the columella length-to-alar width ratio on basal photographs increased (0.19 ± 0.05 versus 0.28 ± 0.05; p = 0.001). On lateral view, the columella-labial angle decreased from preoperatively to postoperatively [138 degrees (interquartile range, 132 to 144 degrees) versus 123 degrees (interquartile range, 122 to 139 degrees); p = 0.04]. Aesthetic ratings performed by four blinded observers also improved from preoperatively to postoperatively (1.6 ± 0.8 versus 2.4 ± 0.7; p = 0.004). As a comparison, bilateral cleft nose patients who did not undergo intermediate cleft tip rhinoplasty (n = 3) of similar ages were subjected to the same photogrammetric and aesthetic analyses, which showed no differences from preoperatively to postoperatively. In combination, the current work suggests that the component restoration technique in the bilateral intermediate cleft tip rhinoplasty improves nasal tip support and aesthetic outcomes.

Split Lateral Forehead Flap for Reconstruction of Upper and Lower Eyelids

Background: Eyelids reconstruction after tumor resection has be one of the most challenging procedures in reconstructive plastic surgery. Small defects may be closed by primary suture or covered by small local flaps or skin graft. But in large eyelids defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. Many techniques have been described, but in this case, the author suggest a split lateral forehead flap designed to cover upper and lower eyelids. Patient and Operation Techniques: A Male 51 years-old-patient, presented himself in our clinic with a basal cell carcinoma involving the right upper and lower eyelids. The tumor had a history of 7 years, without any pain or vision disorders involved. Tumor was widely excised, leaving a full thickness on upper and lower eyelids. The inner lining palpebral was replaced by composite auricular graft following by lateral cantophexy. A lateral forehead flap raised with a right temporal pedicle, and the distal part of flap was split in half, and inset into the upper and lower eyelids defect. The donor region was closed with an STSG from Femur Dextra. After 14 days the flap was divided, the functional result was excellent. Discussion: At first, surgeons were worried of raising forehead flaps beyond the midline, fearing that by splitting the distal flap would cause its compropmise. However, rich anastomostic plexus exists between the major forehead angiosomes lined by the smaller calibre “choke” vessels. Conclusions: Periorbital Basal cell carcinoma resection may leave great defect to the underlying tissue. The need to provide adequate support to this structure requires complex techniques with minimum two flaps. In our case, we performed a split lateral forehead flap with a good functional and cosmetic outcome.

Reconstruction of Cutaneous Nasal Alar Defects Following Melanocytic Nevus Resection.

The reconstruction of nasal alar defects after resection of a melanocytic nevus becomes one of the most challenging procedures for surgeons. Choosing the most appropriate technique is still difficult sometimes. The authors reviewed our cases and published experience on choosing optimal surgical methods to repair different types of nasal alar defect following melanocytic nevus resection. A total of 152 patients who were treated between 2016 and 2019 in Shanghai Ninth People's Hospital were evaluated. The surgical methods included primary closure, full-thickness skin graft, composite auricular graft, interpolated melolabial flap, paramedian forehead flap including hair-bearing paramedian forehead flap. Among the 152 patients with a melanocytic nevus, 49 underwent primary closure, 38 were treated with a full-thickness skin graft, 16 composite auricular graft, 28 were treated with interpolated melolabial flap, and 21were treated with paramedian forehead flap including 14 with hair-bearing paramedian forehead flap. Most skin graft, composite auricular graft, and flaps were survived. Patients who completed follow-up were satisfied with the contour of the nasal ala. After resection of the melanocytic nevus, the surgeon should choose the most appropriate surgical method for alar reconstruction according to the characteristics of the defect and personal desire of patient or the guardian.

Normobaric oxygen therapy increases cartilage survival ratio in auricular composite grafting in rat models

PurposeThis study aims to clarify whether normobaric oxygen therapy improves the survival of auricular composite grafts in rats. MethodsFor 10 male SD rats, 1.5 cm2 composite grafts were harvested from bilateral ear regions including whole auricles. The harvested grafts were transferred caudally and sutured there. The 10 rats were randomly divided into two groups and kept for 21 days in two different circumstances. The first group (Control group: five rats carrying 10 grafts) was kept in room air (20% oxygen) throughout the 21 days, and the second group―named NBO (normobaric oxygen) group (five rats carrying 10 grafts)―was kept in normobaric 60% oxygen for 3 days and then in room air for 18 days. All the 10 rats were sacrificed on the 21st day. Surviving areas of the grafts and the height of the surviving auricular cartilage were examined for statistical comparison of the two groups. Furthermore, the conditions of chondrogenesis occurring around the perichondrium were compared between the two groups. ResultsSurviving areas did not present statistically significant differences between the two groups. The height of surviving cartilage was significantly greater for the NBO group (2610 ± 170 SD µm) than that for the Control group (1720 ± 190 SD µm). Chondrogenesis occurred at positions more distant from the recipient bed in the NBO group than that in the Control group. ConclusionNormobaric oxygen therapy increases the thickness of surviving cartilage in auricular composite grafting in rats, thus suggesting that NBO therapy may also be effective in composite grafting for humans.

Primary Closure Technique for Conchal Auricular Composite Graft Donor Site.

Primary Closure Technique for Conchal Auricular Composite Graft Donor Site.

Comprehensive Algorithm for Nasal Ala Reconstruction: Utility of the Auricular Composite Graft

Defects of the nasal ala are challenging to reconstruct, given its complex three-dimensional structure. Successful repair of these defects needs to provide aesthetic symmetry and preserve nasal function. A wide variety of reconstructive options have been described for nasal ala defects, ranging from skin grafts to locoregional flaps, and also includes the auricular composite graft. However, there are currently no comprehensive guidelines for nasal ala repair, and the versatile role of the auricular composite graft has not been well defined. In this review, we aim to provide a comprehensive algorithm to guide repair of nasal ala defects. Additionally, we compare our experience using the auricular composite graft with the available literature to better define its utility in nasal ala repair.

Columellar reconstruction in children

Defects of the nasal complex can cause significant functional and psychosocial impairment. Nasal reconstruction aims to restore the normal trilaminar structure of the nose, which includes the internal lining, cartilaginous framework, and soft tissue envelope. Among the nasal subunits, the columella is especially challenging to reconstruct due to its unique contour and composite nature. Multiple techniques have been described, each carrying distinct advantages and disadvantages; however, the optimal procedure for an isolated defect of the columella remains elusive. The ideal reconstructive technique should recreate the contour of the columella, provide nasal tip projection, and maintain external valve patency. Additional considerations include matching the pigmentation and texture of the nasal skin while minimizing donor site morbidity. The authors recommend a 2-stage reconstruction with bilateral nasal sill flaps and an auricular composite graft.

Defect Reconstruction of the Nose After Surgery for Nonmelanoma Skin Cancer: Our Clinical Experience.

This study aimed to investigate reconstruction methods according to nasal subunits in patients who were surgically treated with diagnosis of non-melanoma skin cancer of the nose. All patients were retrospectively investigated. This study was conducted between April 2004 and December 2010; 180 patients who were surgically treated with diagnoses of skin basal cell carcinoma, squamous cell carcinoma, cancer of skin appendages, and precancerous lesions and 194 lesions were included. The types of repair performed were divided into seven main groups: Secondary healing, primary closure, skin graft, local flap, auricular composite graft, subtotal reconstruction and prosthesis application. Among the 180 patients, 110 (61.1%) were males and 70 (38.9%) were females. The mean duration of follow-up was 39.8 (range, 32-81) months. Repair was by a local flap, a primary suture, a skin graft, and an auricular composite graft in 133, 16, 38, and 2 defects, respectively. Four defects were left for secondary healing. A prosthesis was applied to one patient. Totally, 194 defects were treated by surgery. Although nonsurgical treatment options such as radiotherapy or cryotherapy may be effectively used, surgery is the main treatment option for cancer of the nasal skin. Nasal subunits have distinct characteristics; thus, optimal reconstruction should be preferred for each subunit. The objective of the reconstruction is not only closing the defect. Closing the defect appropriately with the optimal flap and in proper with the aesthetic subunits is the most important point in reconstruction of the nose.

Auricular Composite Grafting in Functional Rhinoplasty.

AbstractSurgical correction of defects of the internal nasal valve, ala, vestibule, and sill is widely regarded as a challenge due to concerns of poor outcomes of facial aesthetics and nasal function. Auricular composite grafting is a reliable method of reconstruction of deformities of the nasal vestibule and sill. A classification system of types of defects may help surgeons in understanding the indications for composite grafting. Furthermore, we have developed surgical techniques that enhance survival of composite grafts of larger size. Composite grafting is an effective technique to repair a wide range of defects of the internal nasal valve, nasal sill/ala, and vestibule with excellent functional and aesthetic results.

Composite Auricular Chondrocutaneous Graft Is Useful For Lower Eyelid Reconstruction after Surgery for Cancer of the Maxilla

Composite Auricular Chondrocutaneous Graft Is Useful For Lower Eyelid Reconstruction after Surgery for Cancer of the Maxilla

Reconstruction of a large through-and-through defect of the nasal tip using a modified auricular composite graft.

The nose is the most important part in the aesthetic appearance of the face because of its central position. It is difficult to reconstruct a large through-and through defect of the nasal tip among nasal defect deformities because of its unique individual characteristics. In this article, we describe the successful use of a modified auricular composite graft (larger than traditional size) for the reconstruction of large transmural defects of the nasal tip. We retrospectively examined 4 patients diagnosed with a defect of the nasal tip between 2009 and 2011; in our patients, the size of the defect was between 2 × 1 cm and 2.5 × 1 cm. All of them received the same surgical method. The patients were followed up from 3 to 12 months. After the operation, the patients had hyperbaric oxygen therapy for 7 days to improve graft oxygenation. All patients attained relatively full-bodied and smooth nasal contours as well as inconspicuous scars and found their reconstructed nasal tip and alae to be aesthetically satisfactory. Two patients experienced partial epidermal necrosis of the transplanted auricular composite grafts, which was recovered by saline-moistened gauze dressing. All the auricular composite tissue flaps had color change, and the contours of donor ears had little change.

Microsurgical Reconstruction of the Nasal Ala using a Composite Auricular Graft Based on the Superficial Temporal Vessels

Full-thickness defects of the nasal ala can be challenging to reconstruct. The original texture, color and shape of this specific aesthetic unit requires careful planning of the surgical approach and technique in order to minimize donor-site morbidity and repetitive procedures. We describe the use of the chondrocutaneous composite auricular graft to reconstruct a full-thickness defect of the ala of the nose with a successful and aesthetically pleasing outcome.

The effect of platelet-rich plasma on survival of the composite graft and the proper time of injection in a rabbit ear composite graft model.

BackgroundAdministration of growth factors has been associated with increased viability of composite grafts greater than 1-cm in diameter. Platelet-rich plasma (PRP) contains many of the growth factors studied. In this study, we evaluate the effect of PRP injection on composite graft viability and the proper time for injection.MethodsA total of 24 New Zealand White rabbits were divided into four groups. Autologous PRP was injected into the recipient sites three days before grafting in group 1, on the day of grafting in group 2, and three days after grafting in group 3. Group 4 served as control without PRP administration. Auricular composite grafts of 3-cm diameter were harvested and grafted back into place after being rotated 180 degrees. Median graft viability and microvessel density were evaluated at day 21 of graft via macroscopic photographs and immunofluorescent staining, respectively.ResultsThe median graft survival rate was 97.8% in group 1, 69.2% in group 2, 55.7% in group 3, and 40.8% in the control group. The median vessel counts were 34 (per ×200 HPF) in group 1, 24.5 in group 2, 19.5 in group 3, and 10.5 in the control group.ConclusionsThis study demonstrates that PRP administration is associated with increased composite graft viability. All experimental groups showed a significantly higher survival rate and microvessel density, compared with the control group. Pre-administration of PRP was followed by the highest graft survival rate and revascularization. PRP treatments are minimally invasive, fast, easily applicable, and inexpensive, and offer a potential clinical pathway to larger composite grafts.

Evaluation of the use of auricular composite graft for secondary unilateral cleft lip nasal alar deformity repair.

The purpose of this study is to evaluate the surgical outcome after using composite grafts for secondary cleft lip nasal deformities. A retrospective cohort study of one surgeon's outcome of 35 consecutive performed secondary cleft lip nasal deformity repair. Thirty-five patients with secondary nose deformity related to unsatisfactory cleft lip repair were operated using the proposed surgical technique since 2008. All these patients met the study criterion of having anthropometric measurements performed at least one year postoperatively. Measurement of nostril size was performed at the right and left side of the nose, preoperatively and at least one year postoperatively. The study found statistically significant differences between the preoperatory and postoperatory nose measurements. In addition, we have not found statistically significant differences between the cleft and noncleft nostril sizes measured at least one year postoperatively. The findings suggest that the proposed technique is a good alternative to address secondary nose deformity related to cleft lip primary repair.