The columella is unique as a nasal subunit. The nasal
columella has traditionally been a difficult subunit to repair
because of its unique contours, tenuous vascularity, and limited
availability of adjacent skin. Columellar defects can significantly
impair aesthetic appearance. Columellar damage can
be caused by congenital loss, ischemic injuries, trauma, tumor
resection, and vascular malformations. Columella reconstruction
can be very challenging for plastic surgeons.
Defects of the nasal columella can be repaired using
various methods including composite free grafts from the ear
(1,2), nasolabial flaps (3), nasofacial sulcus flaps (4), forehead
flaps (5), extended Abbe flaps (6), and free flaps (7).
Auricular chondrocutaneous composite grafts have been
reported in the literature. The main advantage of these grafts
are avoidance of facial scars and provision of tip support.
However, risk of composite graft loss was reported as a main
complication.
Herein, we report two cases of columellar defect reconstructions
in children using a custom-made columella from
a conchal composite graft with the tongue-in-groove principle.
The main advantages of this technique are that it is a onestage
method; the custom-made columella depends on the
dimensions of the defect, so it can be tailored according to
the dimension of the columellar defect; the use of the tonguein-
groove principle increases the contact surface between the
graft and recipient, therefore, increase the possibility of
survival of the reconstructed columella; with minimal donor
site morbidity.