Chondrocutaneous Preauricular Free Flap for Reconstruction of Nasal Defects Aided by Interposition Vascular Graft

Introduction: Reconstruction of a nose deformity with a full-thickness defect is not an easy procedure because the nose is highly noticeable, being located at the center of the face, and plays an important role in breathing. Esthetics and functionality are equally important. Local flap reconstruction is an option but it has limitations for reconstruction of large defects because of the following the scar and the deformity at the recipient site. Chondrocutaneous preauricular free flaps can be used to provide grafts with satisfactory esthetics. Since the chondrocutaneous preauricular free flap has a short pedicle for anastomosis with the facial artery and vein, in some patients there is a need for extra vessel grafts. The authors have had several successful results using chondrocutaneous free flaps aided by interposition vascular grafts with the descending branch of the lateral circumflex femoral artery and the accompanying vein. Patients and Methods: A total of 6 patients with full thickness defects of the nose participated in chondrocutaneous preauricular free flap operations from 2011 to 2015. Operations were performed under general anesthesia. After dissection around the tissue and scar removal, the flap was designed to be a few centimeters size wide to include cartilage from the helical loop and preauricular skin. After finding the superficial temporal vein by dissection, the incision was extended to the proximal part of the flap and dissection was done below the superficial temporal vessels. To elongate the pedicle of the flap, the descending branch of the lateral circumflex femoral artery, used as a pedicle for the anterolateral femoral flap, and the accompanying vein were harvested together. The harvested descending branch of the lateral circumflex femoral artery and the accompanying vein were placed on the subcutaneous tunnel. End-to-end anastomosis between the pedicle of the flap and the vessel graft as well as between the vessel graft and the facial vessels was done. During flap inset, even though remnant parts were trimmed, sufficient tissue should be left cautiously, and the donor site was closed primarily. Results: All 6 operations were successful. Despite the different etiologies in each patient, the nose defects were not different and the operations were not different either. The operative time varied from 3.5 to 6 hours. No major complications were reported. After the operation, necrosis and donor site complications did not occur, and scarring and deformity of the donor site were minimal. The patients were mostly satisfied with the results. Conclusion: Use of the chondrocutaneous preauricular free flap is not only effective for large defects of the nose, but also makes a good donor if the 3-floor structure and subunit structures of the nose are taken into consideration. Since the pedicle of the flap was short, the authors recruited the descending branch of the lateral circumflex femoral artery and the accompanying vein as a vessel graft. A year after surgery, all of the patients were satisfied with the results.