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- Presentation
Nasal and Eyelid Reconstruction Techniques: Free Cartilage Grafts, Flaps, and Subunit Repair
Description
The speaker reviewed three reconstructive cases and emphasized practical design principles for nasal and eyelid repair. For a small but deep nasal defect with valve collapse and high aesthetic expectations, the panel debated options such as free cartilage grafts, bilobed flaps, and interpolated flaps; the speaker ultimately highlighted a free cartilage graft as a simple, single-stage option that can heal well if kept moist, covered, and minimally manipulated, though many surgeons still prefer to cover the graft with viable tissue. In a more complex through-and-through alar defect with an associated cheek defect, the key message was to treat the cheek and nose as separate subunits, preserve symmetry of the alar base, and use hinge flaps and cartilage sandwiched between them to reconstruct mucosa and skin without forcing a forehead flap if the patient declines it. For the eyelid/cheek defect, the speaker stressed respecting the lower eyelid as a separate subunit from the cheek, using primary or V-to-Y cheek advancement, directing tension upward to avoid eyelid drag, and employing directed granulation to flatten the wound and reduce contraction. Overall, the talk focused on subunit-based planning, preserving contour landmarks like the alar groove and lid-cheek junction, and choosing simpler, reproducible repairs when they can achieve good functional and cosmetic results.
View moreConclusions
- The presentation argues that small nasal ala defects can often be reconstructed successfully with a free cartilage graft, avoiding a more complex cheek-to-nose interpolated flap and reducing the burden on the patient.
- For free cartilage grafts, keeping the graft level with surrounding skin, stabilizing it with through-and-through sutures, and protecting it with simple moist dressings can produce reliable healing in about 3 to 6 weeks.
- A key lesson in nasal ala reconstruction is to preserve the alar groove and maintain nasal valve support, because poor positioning or tension can distort the nostril and compromise function.
- When a defect crosses cosmetic subunits, separating the problem into smaller reconstructive units can yield better aesthetic and functional results than treating it as one large wound.
- For through-and-through alar defects, using hinge flaps to recreate both mucosal and cutaneous surfaces, combined with cartilage sandwiched between them, can avoid the need for a two-stage forehead flap.
- Symmetry of the alar base is emphasized as a critical aesthetic goal, sometimes more important than simply closing the visible skin defect.
- In cheek and lower eyelid reconstruction, designing repairs to avoid vertical traction on the lid helps prevent ectropion and preserves eyelid-cheek balance.
- Directed granulation and V-to-Y advancement can be used to level lower eyelid or cheek defects while minimizing downward pull and maintaining symmetry with the opposite side.
- Overall, the talk suggests that simpler, subunit-based repairs often work better than more elaborate reconstructions when they can achieve the same functional and aesthetic outcome.
- Dan Eisen (ACMS Meeting)