Reconstruction of a Large Full-Thickness Alar Defect Using an Extended Free Composite Flap from the Pinna: A Case Report

Abstract Alar reconstruction can pose a challenging task in reconstructive surgery. Herein, we describe a case of a large full-thickness alar defect (involving the full- thickness of the left ala, 50% of the tip of the nose and extending over the left nasal sidewall and cheek) that was reconstructed using a contralateral free composite pinna flap, which extended into the right temple. A 70-year-old man with a squamous cell carcinoma to the left ala underwent surgical excision and immediate reconstruction with an extended contralateral free composite pinna flap based on a branch of the right superficial temporal artery supplying the helical root and the skin paddle of the supra-auricular area. The patient had an uneventful recovery and the result was aesthetically pleasing without compromising the nostril or the external nasal valve. Based on this case, a free composite flap incorporating the contralateral root of helix and adjacent tissue from the temporal region is an option that could be used in a single-staged procedure for reconstruction of large full-thickness alar defects. One of the challenges of performing free flaps in this area is the paucity of suitable recipient veins. This can be reliably addressed with a vein graft.