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A Viable Reconstructive Combination After Excision of Nonmelanoma Skin Cancer in the Nasal Alar Region

Paul A. van der Eerden, MD; Froukje J. Verdam, MD; Simon C. R. Dennis, BSc, MSc, DLO, FRCS, ORL-HNS; Hade Vuyk, MD, PhD

Arch Facial Plast Surg. 2009;11(1):18-23.

Objective  To assess the feasibility and outcome of free cartilage grafts left to heal by secondary intention in the reconstruction of nasal alar skin defects.

Design  We describe the retrospective analysis of 13 patients who were treated in a single department with the use of free cartilage grafts in combination with secondary intention healing for reconstruction of the alar subunit and lateral nasal wall defects after Mohs surgery for cutaneous cancer. Outcome measures included patient and surgeon satisfaction, alar retraction, cartilage extrusion, nasal valve collapse, revision rate, and time to healing.

Results  All wounds healed uneventfully by secondary intention, and the results were gauged as at least satisfactory by the patient and the surgeon. In 3 patients, minor aesthetic faults were evident; in 1 patient, the underlying cartilage was prominent and a hypertrophic scar also developed; in 1 patient, there was some alar notching; and in 1 other patient, a hypertrophic scar developed. One patient had a functional complaint of nasal blockage on the side that was surgically treated.

Conclusions  Free cartilage implants in combination with secondary intention healing is a relatively simple, cost-effective, 1-stage technique. Our results demonstrate that this alternative reconstructive method is a viable option for small and deep defects of the alar subunit and the nasal sidewall of the nose. The donor site morbidity is limited to the ear.

Author Affiliations: Department of Otolaryngology, Lange Land Hospital, Zoetermeer, the Netherlands (Dr van der Erden); Department of Surgery, Amphia Hospital, Breda, the Netherlands (Dr Verdam); Department of Otolaryngology, Queen Alexandra Hospital, Portsmouth, England (Dr Dennis); and Department of Otolaryngology and Facial Plastic Surgery, Gooi-Noord Hospital, Blaricum, the Netherlands (Dr Vuyk).

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