Surgical Science, 2011, 2, 481-484
doi:10.4236/ss.2011.210105 Published Online December 2011 (
Copyright © 2011 SciRes. SS
Double Chondrocutaneous Composite Free Graft in
Nasal Reconstruction. Report of a Case and Technique
Luigi Maria Lapalorcia1, Fabio Massimo Abenavoli2, Marino Cordellini1
1Plastic Surgery Department, ASL 1 of Umbria, Città di Castello, Italy
2Plastic Surgery Department, San Pietro Ho spital, Rome, Italy
Received September 15, 2011; revised October 12, 2011; accepted October 30, 2011
Full thickness skin grafts and composite grafts are a workhorse in reconstructive surgery of nose and ear de-
fects whether they are originated from trauma, cancer surgery or burns. The reliability of these grafts has
been proved with an established clinical use and morbidity to the donor site is minimal if harvesting and do-
nor site selection if appropriate. Use of double or multiple grafts to reconstruct a complex defect of the nose
has not been described and our report is meaningful for the fact that it describes a further use of the surgical
concept of grafting.
Keywords: Nasal Reconstruction, Composite Graft, Free Chondrocutaneous Graft, Skin Graft, Burns,
Cartilage Graft, Donor Site
1. Introduction
We present the case of an 11 year old female patient that
was involved, 2 years before in a bomb related house fire
in a war zone of the world (Figure 1).
The patient presented stable 1 year after an initial re-
constructive surgery session.
Function of right eye was jeopardized due to insuffi-
cient right upper lid mobility and retraction (vision 3-10).
Diffuse burns to facial soft tissues and neck deter-
mined her inability to h yper extend the neck. Retractions
to lower lip and upper lip determined severe difficulties
when patient was assuming liquid and solid diet.
Scar tissue was universally present from her upper
forehead to her upper thorax where evidence of an hair
bearing area witnessed a previous full thickness skin
graft (FTSG) harvested from her upper right thigh (Fig-
ure 2).
Nasal dorsum, scroll and tip (medial and lateral crura)
where totally absent as a result of fire. Nasal skin was
thin and scarred as a resu lt of the thermal insult.
As demonstrated during a face CT no bone abnormali-
ties or fractures were present. Only a left nasal septal
deviation was evident.
Our surgical planning was structured as follows:
Placement of skin expanders in the upper thoraco-
clavicular area (in number of 4100 cc).
Upper and lower right lid skin grafts to correct ec-
tropion and right upp er lid retraction.
Upper lip debridement and FTSG.
Lower lip debridement and FTSG.
Nasal tip reconstruction using double (bilaterally har-
vested) composite condrocutaneous grafts from the
retroauricular concha.
2. Technique Description of the Latter
Composite grafts have an established role in reconstruc-
tion of full thickness defects of various anatomical
structures of the face and body ranging from the auricu-
lar region, upper and lower lids, after trauma or on-
cologic surgery, alar rim, tip and septal defects, and de-
fects of the fingertips 1-8.
Several donor sites in the auricle have been described
9-10 with minimal morbidity and morphologic altera-
tion. No microsurgical anastomosis are normally possible
as no named suitable vessels are present and tissue
amount to transfer is minimal in size and weight.
Survival of the graft is guaranteed by the vascularity
of the dermal component of the skin of the auricle as
Figure 1. Preoperative status of patient.
Figure 2. View of the upper thorax with hair bearing area
grafted from the upper thigh.
recently described by Tomita et al. 11.
Local pedicled flaps where excluded in this case as the
previous burn sequelae had totally jeopardized the der-
mal vascularization that normally allows survival of fa-
cial pedicled flaps.
We opted for bilateral chondrocutaneous grafts. Skin
of the posterior aspect of the auricular concha was bilat-
erally harvested with the perichondrium and cartilagine-
ous component as outlined in the preoperative marking
and placed on a recipient bed of appropriate size pre-
pared using sharp dissection in order to minimize trauma
to tissues (Figures 3 and 4).
Fixation of the graft was done with 5-0 vicryl and an-
tibiotic ointment and vaseline gauze was applied with a
soft dressing (Figure 5).
Figure 3. Outline of the cartilaginous component of the
composite graft. Attached skin is from the posterior aspect
of the auricular concha.
Figure 4. Suturing of the composite graft to the recipient
site with vicryl rapide 5.0.
Figure 5. Graft in place.
Copyright © 2011 SciRes. SS
Assessment of graft’s survival was verified on POD 5.
3. Discussion
Use of autologous chondrocutaneous graft from the
auricular region has been first described in the fifties by
Sathyanarayana Setty Pr et al. 12 in the sixties 13, in
the eighties 6,7 and in the nineties in a microvascular-
ized variant described by Pribaz and Tanaka 14,15.
Subsequently several applications have been used in
multiple reconstructive setting s such as reconstruction of
ear defects, alar rim, nasal tip, nasal lower third aesthetic
subunits 3-5 with f a v orable results f o r p at ie n ts .
Use of bilateral grafts approached medially to recon-
struct a complete dome in a burned patient has not been
described and the success of the graft was encouraging
for us and aesthetically and function ally effective for the
Minimal morbidity of the donor site for extensive fa-
cial grafting was encountered and no complications oc-
curred 10,11.
Nasal inferior cartilaginous components were re-es-
tablished, nasal valve was reconstructed 16, and infe-
rior and lateral aesthetic units of the nose were restored
(Figure 6). Of course patient selection and accurate
planning of the operation are mandatory for a favorable
outcome and take of the graft. Smoking is contraindi-
Figure 6. Postoperative status of the patient on POD 60.
cated and nutritional status must be assessed. Surgical
technique has to be meticulous and follow up of the pa-
tient should be very close in order to intervene promptly
not only on the grafted area but also on the donor sites to
diagnose and treat complications.
On POD day 1 1 cc of blood was evacuated from the
left ear and organized otohematoma was avoided.
4. Acknowledgements
Special thanks go to: Mrs Anastasia Iliana Eco nomou for
picture editing and language revision.
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Copyright © 2011 SciRes. SS
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