Composite Earlobe Grafts to Reconstruct the Lateral Nasal Ala and Sill

In Brief Numerous operations have been described to address the unilateral cleft lip deformity. One area that has not received significant attention is the deficient join between the nasal ala and the upper lip. Several surgeons have advocated detaching the ala and rotating it medially to restore the nasal sill and decrease the alar flare. Unfortunately, many children with clefts do not have enough available tissue to perform these maneuvers without compromising the nostril opening. In this article, the authors present a technique using composite earlobe grafts with sandwiched cartilage grafts to restore symmetry with the contralateral nostril. This technique has also been used in adult patients undergoing reconstruction because of cancer ablation or traumatic injuries. All patients received adjuvant hyperbaric oxygen therapy. Deficiencies at the junction of upper lip and sill in patients with cleft were ameliorated by the transfer of a pie-shaped composite graft from the ear lobule, occasionally supplemented by a conchal cartilage graft. Hyperbaric oxygen was used to maximize graft survival.