Use of Auricular Composite Graft in Rib Cartilage-Based Rhinoplasty for Contracted Nose Correction

Overview

A contracted nose has shortened and pulled upward from scarring after repeated surgery, and correcting it requires both structural support and additional inner lining. The authors combined rib cartilage septal extension grafts with skin and cartilage composite grafts from the bowl of the ear. Patients were assessed with three dimensional photography before surgery and at 3 months and 1 year.

Sections of note

• Design: retrospective analysis of 43 secondary rhinoplasty patients. Level of evidence therapeutic IV.
• Graft take: 12 patients, 27.9 percent, over 80 percent take; 29 patients, 67.4 percent, 50 to 80 percent; 2 patients, 4.6 percent, 20 to 50 percent.
• Two patients required wound irrigation for infection and additional repair, and were discharged without significant deformity.
• At 3 months, three dimensional measurements showed significant gains: bridge length 4.46 millimetres, nasal height 1.25, tip projection 4.06, and columellar-labial angle 22.75 degrees.
• No significant relapse of these measurements was seen at 1 year.
• The authors state the approach restores the inner, intermediate and outer layers of the nose.

What it means for a patient

• A contracted nose is short of lining, not just support, and a composite graft supplies both skin and cartilage in one piece.
• Partial graft take was the norm rather than the exception. Only about a quarter of patients had over 80 percent survival.
• Despite that, the measured lengthening held at one year, so partial take did not translate into relapse within that period.
• Limits: 43 patients, retrospective, single centre, no comparison group, and follow up of one year.

Why this paper matters

Contracted noses after multiple operations are among the hardest problems in rhinoplasty, and simply adding support does not solve a shortage of lining. Documenting graft take rates alongside measured stability is more informative than reporting appearance alone. Whether the correction holds beyond a year is unaddressed.

Terms

• Contracted nose: a nose shortened and pulled upward by scarring after previous surgery.
• Auricular composite graft: a piece of ear containing skin and cartilage in one block.
• Concha: the bowl shaped hollow of the outer ear.
• Nasal lining: the inner surface of the nose, distinct from the outer skin.
• Septal extension graft: cartilage fixed to the septum that carries the tip in a set position.
• Engraftment or take: successful survival of transplanted tissue in its new site.