Extended applications of vascularized preauricular and helical rim flaps in reconstruction of nasal defects

Background: Composite auricular chondrocutaneous grafting is a well-established technique for reconstructing alar defects. It can provide excellent results because it matches nasal tissue well in terms of color, texture, and contour. However, the size of composite graft that can be transferred is limited by its lack of blood supply. The authors reviewed their experience with the free vascularized preauricular and helical rim flaps for use in the reconstruction of large, full-thickness, nasal subunit defects. Methods: The vascularized preauricular and helical rim flap is based on the superficial temporal vessels. Depending on the nature and size of the nasal defect, the crus helicis, helical rim, preauricular skin, superficial temporal fascia, and temporal bone can be harvested. In addition, a posterior auricular flap is designed to reconstruct the donor site. The authors performed a retrospective review of 63 clinical cases. Results: All 63 patients had full-thickness nasal defects that were reconstructed using this technique between 2001 and 2006. There were 36 unilateral alar defects, 20 alar and sidewall defects, three tip and columellar defects, and one patient with an entire lower third of the nose missing. Another three patients had large composite defects involving the nose and maxilla. The lateral femoral circumflex vessels were used as interpositional vascular grafts in most cases. Flap survival occurred in 61 of 63 cases (rate 97 percent). The functional and aesthetic outcome was satisfactory in the majority of patients. Conclusions: The free vascularized preauricular and helical rim flap is a reliable method of reconstructing nasal defects and has wide clinical applications.