Wedge Shaped Defect in the Alar

Wedge-shaped defects in the alar rim no larger than 1 cm can be covered with a full-thickness composite graft from the auricle (Fig. 5.41 ). These composite grafts have a success rate of 80 %, and livid discoloration during the initial days after graft inset should not cause concern. The skin component should be cut slightly larger than the cartilage, and the fine monofilament sutures should not be spaced too close

Fig. 5.41 Wedge-shaped alar defect reconstructed with a composite graft. a A full-thickness composite graft is taken from the auricular border, which is closed with the excision of small Burow's triangles, slightly shortening the overall length of the auricle (see also Fig. 28).

b Reconstruction of the ala.

Fig. 5.42 Larger alar defects can be reconstructed with a Ne-laton transposition flap from the alar groove.

a The flap is cut about 1.5 cm longer than the measured length, as the end is used for lining (that portion is thinned). Flaps for bearded patients are cut above the hair bulbs. b Appearance after closure of all defects (some revision of the flap base may be required).

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f

i J

Alar Groove

Fig. 5.43 Reconstruction of the alar rim in two stages. a, b Stage 1.

c Stage 2: the end of the flap is inset about 3 weeks later. d Result.

Fig. 5.43 Reconstruction of the alar rim in two stages. a, b Stage 1.

c Stage 2: the end of the flap is inset about 3 weeks later. d Result.

together. The reconstructed ala should be immobilized for 8-10 days. Above all, the dressing should not be changed for the first 6 days, as this would jeopardize capillary ingrowth. Harvesting of the composite graft is guided by a pattern matched to the size and shape of the defect. We generally use the aluminum foil wrapper from suture materials to make the pattern.

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