title: Correction of severe secondary cleft lip nasal deformity using a composite graft: current approach and review.
abstract: In the case of a severe tissue deficiency with a secondary cleft lip nasal deformity, a composite graft can be useful for columellar lengthening or to create symmetrical nostrils. The current study used composite grafts to correct secondary cleft lip nasal deformities with a severe tissue deficiency or severe nostril asymmetry. A total of 19 patients who were born with complete cleft type were operated between 1995 and 1999. Of these patients, 10 were men and 9 were women, and the age distribution was 7 to 35 years old. In 9 patients with unilateral cleft lip nasal deformities and in 6 patients with bilateral cleft lip nasal deformities, columellar lengthening was performed using a composite graft taken from the helix in 14 patients and the contralateral alar rim in 1 patient. In 4 patients with severely asymmetrical nostrils resulting from a short alar rim in unilateral cleft lip nasal deformities, the ear helix was used in 2 patients, whereas in the other two patients, the alar rim of the unaffected side was transferred to the affected side to create a symmetrical nostril by reducing the length of the ala on the unaffected side. The follow-up period ranged from 1 to 3 years, and results were as follows: Four days after the graft, the composite tissue exhibited a pinkish color, and complete survival was confirmed after 7 days. The absorption rate was approximately 10% and the color mismatch became minimal with time. Composite tissue from the ear was found to be useful for full-layer reconstruction of the ala and columella because of its stiffness, thin nature, and similarity. Composite tissue from the alar rim on the contralateral side was also determined to be a good material for full-layer reconstruction of the deficient ala.
authors.affiliation: Department of Plastic & Reconstructive Surgery, Kyungpook National University Hospital, Taegu, Korea.
authors.forename: Byung Chae
authors.initials: BC
authors.lastname: Cho
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Park
authors.forename: Bong Soo
authors.initials: BS
authors.lastname: Baik
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002971:Cleft Lip / Q000601:surgery; D004425:Ear Cartilage / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D009667:Nose Deformities, Acquired / Q000209:etiology* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps