Staged Reconstruction of Nasal Alar Defect with Tunneled Nasolabial Flap and Conchal Cartilage Graft - A Case Report and Literature Review

Background: Reconstruction of complete loss of nasal ala is difficult and challenging due to the complexity of the three-dimensional anatomy and requirement of symmetry to the normal side. Aim and objectives: Various local and distant flaps have been described for the reconstruction of nasal alar defects. We propose staged reconstruction of soft tissue defect with tunneled nasolabial flap, followed by conchal cartilage graft for the reinforcement of the framework in order to provide better functional and aesthetic results. Materials and methods: A 60-year-old man who was admitted due to complete loss of the right nasal ala resulted from a severe facial trauma. At emergency surgery, he received composite graft using defatted avulsed nasal ala. Unfortunately, it failed with necrosis. 3 months after injury, a tunneled nasolabial flap was used for soft tissue defect coverage. 6 months later, a conchal cartilage graft from ear was used for enhancing the support of nostril contour. Results: The shape and texture of the reconstructed nasal ala were acceptable without alar retraction or airway obstruction during inspiration. However, narrowing of the nostril still exists which requires further reconstruction. The donor site scar was concealed in the nasolabial fold. Conclusion: Staged reconstruction of complete nasal alar defect with tunneled nasolabial flap and conchal graft provide both functionally and esthetically acceptable results.