Alar Rim Composite Graft: A Safe and Simple Way to Correct Alar Retraction

다국어 초록 (Multilingual Abstract)

Background The alar rim is a complex structure that ensures the competence of the external valves and the patency of inlets to the nasal airways. Retraction of the alar rim is caused by congenital malpositioning, hypoplasia, or surgical weakening of the lateral crura, with the potential for both functional and aesthetic ramifications. Most previously introduced procedures involved a relatively long operation time and relatively high risks of surgical complications. The purpose of this study is to introduce a novel surgical technique for alar rim connection and to present its results.
Methods After marking the extent of the correction, the recipient alar bed was created by making an incision through the vestibular skin 2-mm cephalad to the rim. Then, the composite graft was harvested from the cymba concha by removing the cartilage with its adherent anterior skin. According to the degree of retraction, the harvested composite graft was divided into 2 pieces considering the symmetry of both alar rims. The composite grafts were inserted into the defects and primary closure was done at the donor site.
Results Our surgical technique was used to correct 12 retracted alar rims in 6 patients. Caudal advancement of the alar rims was observed and the contour of the ala was corrected in all 6 patients. The mean length of follow-up was 1-year, and there were no postoperative complications, such as graft loss or disruption.
Conclusions The alar rim composite graft is a safe and simple technique for correction of short nostril and caudal transposition of the retracted alar rim.

참고문헌 (Reference)

1 Ferreira S, "The primary closure approach of dog bite injuries of the nose" 25 : e216-e218, 2014

2 Rohrich RJ, "The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty" 109 : 2495-2505, 2002

3 Hirohi T, "Surgical correction of retracted nostril rim with auricular composite grafts and anchoring suspention" 27 : 418-422, 2003

4 Meyer R, "Sculpturing and reconstructive procedures in aesthetic and functional rhinoplasty" 4 : 15-39, 1977

5 Klinger M, "Reconstruction of a full-thickness alar wound using an auricular conchal composite graft" 18 : 149-151, 2010

6 Kim JH, "New classification for correction of alar retraction using the alar spreader graft" 36 : 832-841, 2012

7 Haug MD, "Managing the ear as a donor site for composite graft in nasal reconstruction: update on technical refinements and donor site morbidity in 110 cases" 63 : 171-175, 2009

8 손대구, "Large Auricular Chondrocutaneous Composite Graft for Nasal Alar and Columellar Reconstruction" 대한성형외과학회 39 (39): 323-328, 2012

9 Peach AH, "Improved selection and management of the auricular composite graft donor site" 57 : 797-799, 2004

10 Brown JB, "Composite free grafts of two surfaces of skin and cartilage from the ear" 124 : 1101-1107, 1946

11 Adams C, "Composite and free cartilage grafting" 23 : 129-140, 2005

12 Gunter JP, "Classification and correction of alar-columellar discrepancies in rhinoplasty" 97 : 643-648, 1996

13 Ratner D, "An interlocking auricular composite graft" 21 : 789-792, 1995

14 Ellenbogen R, "Alar rim lowering" 79 : 50-57, 1987

15 Guyuron B, "Alar rim deformities" 107 : 856-863, 2001