A Novel Single Stage Reconstruction of Midline Nasal Dorsum Skin Defects Using an Auricular Composite Graft

Abstract

Background: Reconstruction of midline nasal dorsum skin defects following oncologic excision is challenging because of the aesthetic prominence of the region and the limited mobility of surrounding soft tissues. Flap-based techniques are commonly recommended; however, they may be associated with donor-site morbidity, visible scarring, and multistage procedures. Auricular composite grafts are well established for select nasal subunits, but their intentional use for midline nasal dorsum skin reconstruction has not been routinely described. Methods: We describe a novel single-stage reconstructive strategy in which an auricular chondrocutaneous composite graft was deliberately utilized for midline nasal dorsum skin reconstruction following basal cell carcinoma excision. The technique was applied in a carefully selected patient with preservation of the underlying cartilaginous framework. Simultaneous structural support of the nasal dorsum and internal nasal valve was achieved without additional cutaneous incisions. Results: Complete graft survival was observed without partial or total necrosis. At the 6-month follow-up, the reconstructed nasal dorsum skin demonstrated stable contour with satisfactory color and texture match. No graft contraction, secondary deformity, or late complications were noted. Nasal airway patency was preserved throughout the follow-up period. Conclusions: This technical experience suggests that auricular composite grafts may represent a feasible single-stage, low-morbidity alternative to flap-based reconstruction for midline nasal dorsum skin defects in selected cases, while preserving future reconstructive options. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.