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nasal reconstruction
This document discusses nasal reconstruction using composite chondrocutaneous grafts. It provides a brief history of composite grafts, noting their phases of revascularization. Tables show success rates from various studies ranging from 47% to 12% partial failure and up to 16% total failure. A 2cm graft has a 90-95% survival rate. The ideal donor site is the anterior crus of the helix and pretragal skin. Factors for success include graft size over 1.5cm, atraumatic handling, a well-vascularized turn-down flap, and patient cooperation to not smoke, chew, or talk. Advantages over flaps include a one-stage operation, superior donor site, patient comfort, and
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nasal reconstruction
- 1. Nasal Reconstruction with Composite ChondrocutaneousGrafts Dr Sumer Yadav Plastic surgery
- 2. Composite Graft Described byKonig 1887 Phase I Cut Graft Dead White Phase II 6 Hours Post-op Pale Pink Phase III 12 – 24 Hours Post-op Deep “Cyanosis” Phase IV 3 – 6 Days Graft Acquires Healthy Color The Wider the Surface Contact, the More Rapid the Revascularization
- 3. AUTHORAUTHOR YEARYEAR #of# of GraftsGrafts PARTIALPARTIAL FAILUREFAILURE TOTALTOTAL FAILURESFAILURES KonigKonig 19141914 4747 22 (47%)22 (47%) LimbergLimberg 19351935 4747 6 (12%)6 (12%) Brown &Brown & CannonCannon 19461946 5050 4 (8%)4 (8%) Symonds &Symonds & GrikelairGrikelair 19561956 3636 22 2 (11%)2 (11%) ConleyConley 19561956 1212 2 (16%)2 (16%) Davenport &Davenport & BernardBernard 19591959 1717 33 Rees et alRees et al 19631963 3535 22 Dufourmental &Dufourmental & PesteurPesteur 19731973 4343 4 (9%)4 (9%)
- 4. A 2cm CompositeGraft has a 90 - 95% Survival Rate No Part of the Composite Graft Should Be More than 1cm from a Free Edge
- 16. Cartilage Sheet Actsas a Barrier to Revascularization Turn-Down Flap for Nasal Lining Provides Large Surface Area for Graft Revascularization
- 17. The Ideal DonorSite: Anterior Crus of Helix & Pretragal Skin
- 18. Most Closely Resembles Nasal AlaIn: Contour Thickness Size Texture Color
- 68. Width Number CompleteTake Partial Loss Major Loss (Less than 20%) (None Complete) >2.5cm 61 54 (89%) 1 6 1.5 – 2.5cm 342 318 (93%) 7 17 <1.5cm 97 93 (96%) 3 1 500 Composite Grafts 1979 - 2000
- 69. Etiology of Defect TechnicalChanges Over 20 Years Skin Cancer 478 Trauma 16 Rhombergs 3 Hemangiomas 2 Congenital Nevus 1 Use of Contralateral Ear Tongue in Groove Alar Rim No Primary Grafts – Allow for complete Healing , at Least 3 Months 6-0 Monocryl Dermal Sutures to Recipient Bed to Eliminate Dead Space
- 70. Success Depends Upon:Essentials for Success Optimal Recipient Bed Graft Size Atraumatic Handling of Graft ? Cooling Well Vascularized Turn-down Flap Atraumatic Tissue Handling Cool the Graft for 72 Hours Strict patient Cooperation No Smoking No Chewing Minimal Talking
- 71. Disadvantages of Flaps Advantages of CompositeGrafts Tendency Toward Chronic Edema Lack of Aesthetic Definition of Ala Often Requires Revision Occasional Unsightly Donor Site Scar Usually Require Several Stages One Stage Operation Superior Donor Site Patient Comfort Superior Aesthetic Result Does Not Preclude Flaps
- 72. 5% Revisions on Patients WithComplete Take
- 73.