Reconstruction of full-thickness defects of the nasal alae has always been a challenge. Local flaps are commonly used but often result in facial scars and bulky alae that require secondary revisions. The structural similarities between the nasal alae and auricular helices have allowed the use of free helical composite grafts to repair small nasal defects of less than 2.0 cm. Recent delineation of vascular territories of the ear has allowed the use of vascularized helical free flaps in the repair of large alar defects. Successful reconstruction of a 3.2 cm x 3.0 cm full-thickness alar defect, with a chondrocutaneous microsurgical free flap from the root of the auricular helix, is presented. The reconstruction was satisfactory as to contour, symmetry, and color match over a one year follow-up.
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