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.

NEW SOLUTIONS IN NASAL ALA RECONSTRUCTION

The article describes the technique and results of the method of single-stage nasal ala reconstruction based on a modified puzzle-flap. The developed method has been applied for nasal ala reconstruction in 10 patients after malignant tumor excision. The anatomical and functional outcomes of the reconstruction were evaluated with the use of NAFEQ questioning and visual analogue scale. The external skin, internal nasal lining, and cartilage support of nasal ala were restored in a single-stage procedure in all the cases. The natural appearance and contour of neoala were achieved with a minimal correction in the donor area. Partial necrosis of a flap was observed in one case. The anatomical outcome of the reconstruction was evaluated as completely satisfactory or satisfactory in 9 out of 10 patients (90%) according to NAFEQ. The average evaluation of the results of the reconstruction by the VAS scale was 81.0 ± 6.8 (100-point scale), the minimal value - 70 points, the maximal one - 95 points. Nasal function was not disturbed in any case. The proposed method of nasal ala reconstruction allows to achieve acceptable functional and anatomical results in a single-stage procedure.