Introduction:

Reconstruction of composite alar nasal defects has historically been a difficult problem. The ascending helical rim has been described as containing all the structural elements as well as intrinsically mimicking the shape of the nasal ala. Our experience with the ascending helical rim free flap reveals it to be an ideal choice for complex composite defects of the nasal ala. Through our experience with 5 flaps we have established a flap design that makes the tissue quick and easy to harvest. We have found that local recipient vessels are usually consistent in their size and location reducing the likelihood of requiring vein grafts.

Materials and Methods:

We retrospectively reviewed the indications and outcomes of 5 patients undergoing ascending helical rim microvascular reconstruction of the nasal ala.

Results:

5 patients underwent ascending helical rim reconstruction of the nasal ala. The indications for reconstruction included traumatic full thickness ala defects in 2and full thickness ala oncologic defects in 3. The contralateral ear was harvested in all cases. Flap survival was 100%. There were no take backs. Flap monitoring was performed clinically and the implantable venous Doppler was utilized in 3 cases. Post operative complications included one generalized impetigo skin infection and the silicone cuff of one Doppler probe required delayed removal in the office. Local vessels were utilized in all but the first case and in another where a previous maxillectomy and radiation had been performed. Minor secondary revisions were required in 2 cases. There were no donor site complications. All patients were satisfied with the aesthetic outcome of both the reconstruction and the donor site.

Conclusion:

The ascending helical rim free flap is an ideal choice for reconstruction of complex composite nasal alar defects. Nasal ala lining, cartilage and skin coverage is provided with one flap. The contour of the contralateral helical rim is a excellent match for the nasal ala, thus eliminating the need for frequent revisional surgeries to provide a acceptable shape to the traditionally reconstructed nasal ala. Donor site scarring is very acceptable and most scarring is partially hidden by the patient's hair. The helical rim free flap has a relatively straight forward design, making it a easy flap to harvest and easy donor site to close. Local recipient vessels are consistent in location and frequently of adequate size for microvascular anastomosis. Given the potential for a single stage reconstruction of full thickness nasal ala defects, the excellent contour and straight forward harvest, the helical rim free flap should be considered as a potential first choice in nasal ala reconstruction.