Nasal columella reconstruction with a composite free flap from the root of auricular helix

Abstract

Defects of the nasal columella result in significant cosmetic and functional deformities. Over the years, a variety of methods for nasal columella reconstruction have been described in the literature, as have the technical difficulties of reconstructing this subtle structure. Here, a successful reconstruction of a 3.0 x 2.0 cm-wide nasal columella defect, with a chondrocutaneous microsurgical free flap from the root of the auricular helix, is presented.

More than just the helix: A series of free flaps from the ear

“…Consequently, the survival of composite grafts diminishes as the graft size increases and is often limited to a maximum of 1 cm graft size (Lehman, Garrett, & Musgrave, ). The use of free helical flaps has thus gained in popularity and has been increasingly reported in the literature (Bakhach, et al, ; Dabernig et al, ; Li et al, ; Oh et al, ; Ozek et al, ; Parkhouse & Evans, ; Pribaz & Falco, ; Shenaq et al, ; Shimizu et al, ; Tanaka et al, ; Zhang et al, ). To date, our series of free auricular flaps ( n = 13) is the second largest reported.…”

“…The first free helical flap was described over 30 years ago by Parkhouse and Evans (Parkhouse & Evans, ) and later popularised by Pribaz and Falco (Pribaz & Falco, ). Since then its use has increasingly been described in the literature (Dabernig, Ampomah, & Watson, ; Li et al, ; Oh, Jeon, & Koh, ; Ozek, Gundogan, Bilkay, Alper, & Cagdas, ; Ozek, Gurler, Uckan, & Bilkay, ; Shenaq, Dinh, & Spira, ; Shimizu, Oatari, & Uehara, ; Tanaka, Tajima, Tsujiguchi, Fukae, & Ohmiya, ; Zhang et al, ). The attributes of the ascending helix in providing remarkably similar tissue anatomically and aesthetically to the nasal‐alar region are well recognised.…”

Supermicrosurgery: Principles and applications

“…The groin flap can be an example, perhaps one of the most ideal donor sites with minimal morbidity but was difficult to use due to the short pedicle and pedicle with short diameter, now by using supermicrosurgery technique, superficial circumflex iliac artery perforator (SCIP) flap is ideal for soft tissue reconstruction that requires thin flaps . Small boutique flaps with small perforator and short pedicle can now be used without hesitation to reconstruct various defects of the hand, nose, toes, small facial defects (Figure ) . The classical flaps such as anterolateral thigh flap, deep inferior epigastric artery perforator flap, and others do not need a lengthy pedicle but only a short segment reducing the harvest time and proficiency of reconstruction.…”

Reconstruction of the columella and the tip of the nose with an island-shaped forehead flap

“…The literature describes numerous reconstructive methods. Other reconstructive methods were also described: nasolabial flaps [18][19][20][21] , flaps of the lower lip, frontal lobes 22-27 , dermal or fascial flaps from the dorsum of the nose, skin flaps from the nasal wings or from the nasal vestibule and the nasal septum 28 , cheek flaps, or tubule or islandshaped flaps from the neck regions, periauricle flaps, scalp flaps, a skin tubule from the upper arm or back of the hand and microvascular muscle flaps from the ear 29 . This method was later modified several times 9 drocutaneous transplant, and as giving region he used the nasal wing.…”