title: Nasal ala reconstruction with a crus helix composite graft: a stepladder approach.
abstract: BACKGROUND
  Defects of the nasal ala present a complex reconstructive challenge. Composite grafts comprise all layers required to successfully reconstruct these full thickness deformities making them the ideal reconstructive method, yet they are usually avoided because of unjustified disreputable failure rates.
  
  
  OBJECTIVE
  The authors introduce a stepladder approach for alar reconstruction with a crus of helix composite graft according to the severity and complexity of the defect.
  
  
  METHODS
  Data from 25 patients who underwent correction of full thickness alar defects with composite grafts was collected and reviewed.
  
  
  RESULTS
  There were no complete graft failures in any of the cases. Ten patients (40%) had partial graft necrosis ranging from 5 to 50% (average 18%); two of them (20%) were heavy smokers.
  
  
  CONCLUSIONS
  Composite grafts should be considered for reconstruction of full thickness nasal ala defects, given the correct surgical technique is implemented.
authors.affiliation: Mohs Micrographic Surgery Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Isaac
authors.initials: I
authors.lastname: Zilinsky
authors.forename: Nimrod
authors.initials: N
authors.lastname: Farber
authors.forename: Josef
authors.initials: J
authors.lastname: Haik
authors.forename: Oren
authors.initials: O
authors.lastname: Weissman
authors.forename: Hadar
authors.initials: H
authors.lastname: Israeli
authors.forename: Eyal
authors.initials: E
authors.lastname: Winkler
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009667:Nose Deformities, Acquired / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013524:Surgical Flaps; D016378:Tissue Transplantation / Q000379:methods*; D016896:Treatment Outcome