DS09 Fifteen years’ experience of the ‘Omega’ composite graft for full-thickness defects of the nasal ala and distal nose

Abstract

Full-thickness nasal defects are challenging to reconstruct. Recreating the missing inner mucosal nasal lining may be achieved by skin grafting, subcutaneous or mucosal perichondrial hinge flaps or interpolated, turnover flaps. Over 15 years, we have used the Omega composite graft (OCG) to recreate the inner nasal lining and provide structural integrity to the alar rim and distal nose. The OCG is harvested from the antihelix and concha. The antihelical component is sized to match the native missing alar rim and provides a chondrocutaneous batten upon which to place a local or interpolated flap. The central portion of the OCG comprises a dome-shaped perichondrial–cutaneous segment approximating the dimensions of the missing nasal lining; conchal cartilage may also be harvested for additional structural support. The graft is sutured into place, ensuring the cutaneous aspect of the ‘dome’ forms the inner nasal lining. The graft’s inferior batten is sutured into pockets, recreating the natural convexity of the alar rim. The antihelical donor site is repaired primarily and the conchal bowl left to heal secondarily. Skin coverage with local or interpolated flaps provides a robust overlying vascular supply. We have utilized the OCG in 29 patients (20 male, 9 female; mean age 71 years; 25 basal cell carcinoma, 4 squamous cell carcinoma). Defect size has ranged from small, full-thickness defects of the nasal alar to complete loss of the alar subunit extending onto the nasal sidewall. A single case of apparent graft failure leading to delayed alar retraction and a degree of nasal airway obstruction was seen. No cases of prolonged donor-site morbidity, discomfort or perichondritis have been encountered. Patient-reported outcome measures were rated as good or excellent. The OCG is a highly versatile and reproducible method of recreating the nasal lining and providing structural integrity to the distal nose in full-thickness nasal defects.