Grafting in Nasal Reconstruction

Nasal reconstruction after tissue loss requires understanding of multiple complex surgical techniques and principles aimed at restoring anatomic integrity, function, and aesthetics of the nose. The reconstruction form and function of the nose are generally challenging when compared to other regions of the face. The outer skin and soft tissue envelope the cartilaginous and bony structure, and the mucosal lining should be considered in the reconstruction of each defect. This chapter is mainly focused on graft materials that are commonly used for nasal reconstruction. A graft is any type of tissue that is harvested from a donor site and transferred to a recipient site without carrying its own blood supply. After transplantation, a newly formed blood supply (angiogenesis) grows toward the graft. Grafts are divided into three categories according to their sources: (1) autografts, (2) homografts, and (3) xenografts. Autografts, or autogenous grafts, designate tissues that are harvested from a site and transplanted on other site of the same patient. Skin, cartilage, fascia, fat, and bone grafts can be used for the reconstruction of various nasal defects or deformities. Indeed, autogenous grafts are the gold standard graft materials for nasal reconstruction due to low rates of rejection, infection, and extrusion. If the donor and recipient are the same species but a different host, the graft is called as homograft. Homograft is divided into two groups: (1) isograft (donor and recipient have the same genetic material as in monozygotic twins) and (2) allograft (the tissue is transferred between genetically nonidentical members of same species). Xenografts are tissue that is harvested from one species and transplanted into another species. Xenografts are generally indicated for closure of post-Mohs surgery in massive wounds, and act as biological dressings to allow for wound granulation and epithelialization.