Nonanatomic free cartilage batten grafting with second intention healing for defects on the distal nose

Background: Defects of the distal nose, particularly the nasal ala, pose a reconstructive challenge due to the lack of loose adjacent tissue and proximity to a free margin. Objective: We report our experience using nonanatomic free cartilage batten grafts in combination with second intention healing for nasal ala defects. Methods: A retrospective study of distal nose defects repaired using nonanatomic free cartilage batten grafting with second intention healing was performed. Detailed data on the quality of the scar, post-operative complications, free margin distortion, functional impairments, and patient satisfaction were recorded. Digital images were also shown to an experienced fellowship-trained Mohs surgeon to assess the overall aesthetic outcome using a 5-point score ranging from poor to excellent. Results: Sixteen subjects were included in the study. Complications were common, but minor. Five (∼31%) subjects had subtle contour depressions, three (∼18%) subjects had excessive granulation tissue, two (∼12%) subjects had post-operative ear pain at the donor site lasting up to 10 days, and one (∼6%) subject had a hypertrophic scar at the recipient site. There were two occurrences (∼12%) of mild alar notching but no occurrences of significant alar margin distortion or nasal valve dysfunction. In terms of aesthetic outcome, seven (∼43%) were assessed by an independent fellowship-trained Mohs surgeon as having excellent aesthetic outcomes, six (∼38%) were very good, and three (∼19%) were good. All sixteen subjects reported satisfaction on follow-up evaluation. Conclusions: Nonanatomic free cartilage grafting with second intention healing allows for facile, single-step repair of nasal ala defects with high patient satisfaction and aesthetically pleasing results. This provides an attractive alternative to other flap techniques, skin grafting, and healing via secondary intention.