The role of cartilage and bone allografts in nasal reconstruction

Nasal reconstruction is challenging, considering surgical techniques complexity and difficulties in remodelling a tridimensional structure. Reconstructive requirements are: correct deformity evaluation, selecting the most suitable treatment option, respecting the principle of aesthetic subunit, appropriate reconstruction of each affected nasal layer, long-term stabile functional and aesthetic results. Reconstructive procedures range from simple to very complex. Conventional techniques can fail in restoring a satisfactory appearance in severely disfigured patients, for whom a new possibility arises: Vascularized Composite Allografts (VCA) transplantation.

In this paper, we focus on nasal skeletal framework restoration. Structural defects may require a large amount of reconstructive material obtained usually from cartilage or bone autografts. Autologous cartilage is the gold standard in nasal architectural recovery, but in some cases, autologous graft sources are not available, imposing the necessity to use alternative solutions represented by the allografts or alloplastic materials. We analysed the specific features of skeletal allografts used in nasal reconstruction.

With current clinical experience, the use of cartilage and bone allografts (especially irradiated cartilage homografts) shows a promising reconstructive option for nasal structural defects. For extensive facial defects, including midface deformities, impossible to restore with traditional surgical techniques, a new reconstructive era was open through the development of the VCA field.