A Simpler Way to Reconstruct Nostrils

A single-stage technique for nasal alar reconstruction after offers cosmetic and functional results that are nearly as good as the standard two-stage procedure.

The most common method for nostril reconstruction following defects caused by deep Mohs micrographic surgery for cancer requires two stages. The first involves taking cartilage from one part of the body and skin from the cheek or forehead to create a special skin flap, with the cartilage providing support to prevent alar retraction or collapse. The flap stays in place for about three weeks so that the blood vessels can grow. Patients then return to the operating room, where the flap is removed after the tissue and blood vessels have grown over the cartilage, ensuring everything stays in place.


The new technique, developed by researchers at the University of Michigan Comprehensive Cancer Center (Ann Arbor, USA) uses a full-thickness skin graft overlying a separately harvested auricular cartilage graft. The procedure skips the skin flap (and the need for a second procedure), but still appears to allow for the cartilage to take hold and keep its place, without the nostril collapsing or curling. A study to evaluate the aesthetic and functional outcomes of the new procedure in 20 patients showed good to very good esthetic results, with minimal scarring. The study was published in the March 2013 issue of JAMA Facial Plastic Surgery.

“The incremental benefit with a cheek flap is not worth it for some patients. The ability to do something less but still get the same quality of results is important,” said lead author Jeffrey Moyer, MD. “This could save people a lot of effort and time. The last thing people want to do is return to the OR. It allows us to spare people multiple surgeries or a scar that dominates the cheek.”

Mohs micrographic surgery involves removing a skin cancer one layer at a time and examining these layers under a microscope immediately after they are removed. This procedure allows for a close examination of each layer of skin to detect cancer cells. It also allows a minimal amount of tissue to be removed while ensuring complete removal of all the cancer cells.

Related Links:
University of Michigan Comprehensive Cancer Center