THE CHONDROCUTANEOUS EAR HELICAL FREE-FLAP FOR THE RECONSTRUCTION OF THE DEFECTS OF THE NASAL TIP, COLUMELLA AND OR ALA/

Reconstruction of the full-thickness defect of the tip of nose, colume lla, and ala has always been a challenge. Local flaps can be used, but this often results in a bulky nose with an unsatisfactory aesthetic a ppearance requiring secondary surgical procedures. The use of the ear as a donor site for a microvasuclar free flap, although not general co nsensus despite structural similarities between the nose and ear, offe rs a possibility of a good reconstruction for such patients. Five pati ents pre sented with composite tissue defects of the tip, columella an d ala of the nose resulting from human bites. Reconstruction was perfo rmed early in order to avoid possible infection. The free flap was des igned and elevated from the upper part of the helix and concha of the opposite ear; the flap matched the traumatic defect on the nose and wa s based on the anterior auricular branches of the superficial temporal vessels. The free flap was brought to the defect and sutured to the m argins. Direct end-to-end anastomosis of both vessels was performed in four patients while a venous grafts was needed in one patient. The do nor flap area was closed directly. The follow-up period ranged from si x months to five years, The reconstruction was satisfactory as to cont our, symmetry and colour match in four patients. The final aesthetic r esult was obtained by touch-up procedures under local anesthesia. The donor site deformity was minimal. In one patient, the free flap was lo st due to venous thrombosis and late reintervention. The chondrocutane ous free flap represents a dependable vascularized composite tissue tr ansfer that offers a straightforward one-stage reconstruction of tissu e defects of the tip, columella, and ala of the nose. The additional a dvantages of freedom in the flap design and structural similarity betw een the nose and ear makes it an ideal choice for such defects.