Cartilage grafts for alar reconstruction in nasolabial interpolation flap surgery may negatively affect breathing function and cosmesis: A retrospective study.

BACKGROUND

Free cartilage grafts are often used to support the nostril during nasolabial interpolation flap (NLIF) reconstruction of alar defects. Indications for free cartilage grafts, and their effect on cosmetic and functional outcomes are unclear.

OBJECTIVE

To identify factors associated with free cartilage grafts and compare outcomes with and without cartilage grafts.

METHODS

A retrospective cohort study of consecutive NLIFs for alar reconstruction from September 2008 to May 2024. The primary outcome was factors associated with cartilage graft use, assessed with univariable analysis. Secondary outcomes were donor site complications and factors affecting compromised breathing and scar revision, assessed with multivariable regressions.

RESULTS

Of 278 NLIFs for alar defects, 43.2% (120/278) included an auricular free cartilage graft. Cartilage grafts were more likely with fewer years of surgeon practice and with tumors limited to the alar subunit or involving muscle. A total of 3.3% (4/120) had a cartilage donor site complication. Patients with cartilage grafts were 3 times more likely to have compromised breathing (odds ratio: 2.92, CI: 1.09-8.66, P = .039) or scar revision (odds ratio: 3.11, CI: 1.47-6.90, P = .004).

LIMITATIONS: A single center, retrospective design.

CONCLUSION

Cartilage graft use with NLIFs is associated with defect characteristics and surgeon experience. They may increase risk of compromised breathing and surgical scar revision, questioning their necessity for many NLIFs.