title: Use of a skin-fat composite graft to prevent alar notching: an alternative to delayed postoperative repair.
abstract: BACKGROUND
  Full-thickness defects of the alar rim can be challenging to repair and often require the use of multistaged interpolated flaps. Alar notching is a known complication of these procedures even after cartilage batten grafts have been placed to support the alar framework. Standard techniques for repair of alar notching involve reinsertion of a cartilage graft, usually at the time of alar groove reconstruction 3 months postoperatively.
  
  
  OBJECTIVE
  We present a technique to prevent alar notching associated with nasolabial interpolation flaps. If early notching is noted at the time of pedicle division, preemptive placement of a skin-fat composite graft can obviate the need for additional procedures.
  
  
  METHODS
  A case report detailing the procedure and a review of the options for repair of alar notching are provided. RESULTS. Placement of a skin-fat composite graft harvested from the divided pedicle flap resulted in correction of alar notching.
  
  
  CONCLUSIONS
  This procedure is presented as an alternative to delayed cartilage grafting for repair of alar rim notching after placement of an interpolated pedicle flap. If notching is noted early, correction at the time of pedicle division allows for use of available tissue for composite grafting, avoidance of a delayed reconstructive procedure, and a good functional and cosmetic
authors.affiliation: Department of Dermatology, Columbia University Medical Center, New York, New York 10032, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Geyer
authors.forename: Fiona
authors.initials: F
authors.lastname: Pasternack
authors.forename: Christopher
authors.initials: C
authors.lastname: Adams
authors.forename: Desiree
authors.initials: D
authors.lastname: Ratner
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000368:Aged; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D015580:Mohs Surgery; D009666:Nose / Q000473:pathology / Q000601:surgery*; D012225:Rhinoplasty; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps