Reconstruction of defects involving the nasal ala can be challenging because of the complex anatomy, small size, and firmness of this area. The most common approaches, such as local flaps or full-thickness skin grafts, often yield unpredictable cosmetic outcomes and may result in noticeable scarring in adjacent areas. Herein, we present the surgical technique of a dermofat graft, a simple and effective solution for defects of the nasal ala.
SolutionThe donor site should be selected from an area with sufficient subcutaneous fat and skin laxity, such as the inner forearm or thigh. After designing and elevating an epidermal “window,” the graft is harvested, including dermis and adipose tissue. The graft is then placed onto the surgical defect with the dermal side positioned outward to provide anchorage for fixation using a fast-absorbing 4-0 suture (Video).
During the postoperative period, a thick crust typically forms over the graft. A moist dressing with petrolatum ointment is recommended until the crust detaches, usually within 2 weeks. Because a resorbable suture is used, removal is generally unnecessary, although sutures may be gently removed after 2 weeks if desired. Reepithelialization is completed within approximately 4 weeks (Supplemental Fig. 1). This technique offers a reliable alternative to more invasive reconstructive methods. The fat layer prevents wound collapse or retraction, whereas the dermis facilitates natural reepithelialization from the surrounding healthy skin, achieving a favorable cosmetic result without the need for additional scars in adjacent cosmetic units (Fig. 1).1,2
Patient consent
The authors obtained written consent from the patients for publication of their photographs and medical information in print and online, with the understanding that this information may be publicly available. Patient consent forms were not provided to the journal but are retained by the authors.
FundingNone declared.
Conflicts of interestNone declared.
The following are the supplementary data to this article:
Demonstration of reconstruction of a nasal ala defect using a dermofat graft. After selecting an appropriate donor site, the graft is marked to match the dimensions of the defect. A superficial incision is made through the epidermis, elevating a “window” to expose the deeper dermis and adipose tissue (note the punctate dermal bleeding). A sharp incision is then performed to carefully harvest the graft, and the donor site is closed with a simple suture. The graft is subsequently placed onto the wound bed with the fat layer in direct contact with the tissue, whereas the dermal side is positioned outward to provide anchorage for simple sutures. A moist dressing is applied to the surgical site. During the 1st postoperative visit, a large crust usually appears at the surgical site and can be managed with antibiotic ointment until resolution. Reepithelialization is completed in approximately 4 weeks.
