J AM ACAD DERMATOL
VOLUME 43, NUMBER 5
Byrd, Otley, and Nguyen 835
Table I. Functional and cosmetic results: Physician
and patient assessments
Outcome,
No. of patients (%)
Assessment
Functional
Cosmetic
Physician (n = 18)
Excellent
Good
14 (78)
4 (22)
0 (0)
9 (50)
6 (33)
3 (17)
Poor
Patient (n = 23)
Excellent
Good
20 (87)
3 (13)
0 (0)
11 (48)
12 (52)
0 (0)
Poor
cartilage graft to allow optimal effect, but this is
uncommon. Patients will subjectively detect
improved nasal air passage. The remaining soft tis-
sue defect is closed with an appropriate cutaneous
flap or graft (Fig 2, C). Prophylactic antibiotics were
given in the majority of cases.
Fig 3. Representation of alar batten cartilage graft
secured in an alar defect. (By permission of Mayo
Foundation.)
RESULTS
All of our patients believed that they had good to
excellent function and cosmesis (Table I). By physician
assessment, however, all patients had good to excel-
lent function, but 17% had poor cosmesis (Table I).
Poor cosmesis by physician assessment was due to
suboptimal outcome of cutaneous flap or graft closure
rather than the use of cartilage itself. A carefully select-
ed flap or graft type and thickness is essential. A flap
that is too thick may create a trap-door phenomenon
or poor cosmesis, or both. A flap that is too thin may
result in protuberance of the cartilage graft.
Necrosis of a full-thickness skin graft overlaying
the cartilage graft occurred in one patient. Skin
grafts were used sparingly, owing to concern about
ischemia. Despite cartilage graft placement, postop-
erative stenosis of the nasal valve occurred in 5
patients, 4 of whom deemed it minimal, and 1 of
whom deemed it moderate. No patient postopera-
tively experienced functionally significant compro-
mise of the nasal valve. Infection occurred in one
patient and resolved after a 7-day course of cephalex-
in. A trap-door phenomenon developed in one
patient and improved after injection with triamcin-
olone (5 mg/mL). Five patients experienced localized
tenderness at the donor site, which was relieved by
oral administration of acetaminophen or ibuprofen
and resolved in 2 to 6 weeks.
a simple cutaneous flap or graft closure is all that is
needed to obtain good to excellent functional and
cosmetic results. However, when surgical defects
result in significant nasal valve collapse, alar batten
cartilage grafts are a useful and effective tool for
restoration of nasal valve function and form.
The major advantages to alar batten cartilage graft-
ing are that it is autologous tissue, has a similar con-
tour to that of the alar rim, and establishes patency of
the nasal valve. The primary disadvantage to using
autologous cartilage is the creation of an additional
surgical wound and associated potential comorbidi-
ties such as chondritis or infection, which were rare.
In patients with full-thickness alar defects or func-
tional compromise or both, alar batten cartilage
grafts serve as a useful adjunct to cutaneous closure.
We have achieved good to excellent functional and
cosmetic results in the majority of cases with mini-
mal morbidity after cartilage grafting. Alar batten car-
tilage grafts are useful for functionally significant alar
rim defects.
REFERENCES
1
2
3
. Baker SR, Swanson NA, Grekin RC. Moh’s surgical treatment and
reconstruction of cutaneous malignancies of the nose. Facial
Plast Surg 1987;5:29-47.
. Swanson NA. Classifications, definitions, and concepts in flap
surgery. In: Baker SR, Swanson NA, editors. Local flaps in facial
reconstruction. St Louis: Mosby; 1995. p. 63-74.
. Cook TA, Brownlee RE. Rotation flaps. In: Baker SR, Swanson NA,
editors. Local flaps in facial reconstruction. St Louis: Mosby;
1995. p. 75-90.
DISCUSSION
Many factors must be taken into account when
planning nasal alar reconstruction. In most instances,
Ssidorowa
