Nasal Alar Reconstruction Through Free Grafting Of Auricular Composite Flaps With Retrograde Blood Supply Of The Facial Artery

Objective:To explore the technique for nasal alar reconstruction through free grafting of auricular composite flaps with retrograde blood supply of the facial artery.Methods:The facial artery and the facial vein were separated at the inferior margin of mandible and then isolated for about 2cm to the proximal parts.Following ligation of initial segments,the facial vessels were mutilated and liberated from the inferior margin of mandible to the distal parts for about 2cm.Proximal parts of the liberated facial vessels moved to the incision at the lateral side of the nasal alar through the tunnel.According to the unaffected side of the nasal alar,determined the arc of the nasal alar and the auricular composite flap we need.Then we designed a ligule fascia flap of skin at the lateral side of the auricular composite flap and separated the auricular composite flap at the surface of deep temporal fasia which included the superficial temporal vessels and the branch of the fascia flap.The telecentric end of the superficial temporal vessels were separated.The proximal parts of the superficial temporal vessels were separated from other tissue for about 1.5cm;following good morphological moulding of the nasal alar,proximal parts of the facial vessels and of the superficial temporal vessels were anastomosed under an operating microscope.Results:Five patients were followed up for 6-12 months,all had their vessel pedicles successfully anastomosed to the proximal parts of the facial vessels.All the flaps survived with a satisfactory esthetic result after operation.Three patients recovered the form of the affected side of nasolabial sulcus by repaired auricular composite tissue and nobody had the damage of marginal mandibular branches and facial nerve buccal branch.Conclusion:To use the auricular composite tissue can provide adequate coverage for an alar defect,also match the texture,color and thickness of the alar skin.But we have to graft vessels which increase the injury to the patient,because the vessels by the tissue just have 2-3cm length.This new method has following advantages: 1.The anastomosing caliber of vessels are large.2.The quantity of vascular anastomotic stomas is small.3.The successful rate of operations is high.The method with retrograde blood supply of the facial artery could facilitate more efficient clinical popularization of nasal alar reconstruction through free grafting of auricular composite flaps.