12. Do composite grafts work? Should you cool them? HBO them? What is the upper limit of size that you can expect to live?
Answer:
Composite grafts include full-thickness skin and accompanying perichondrium and cartilage. The auricle is the most common donor site, using the root of the helix, the conchal bowl, or helical rim. The opposite side of the nose may also be used as a donor site. Composite grafts are useful for full-thickness defects of the alar rim or columella and allow one-stage nasal reconstruction. However, in the long-term, they tend to appear thin and shiny and have difficulty blending well with the surrounding tissue. Although data does not exist to support it, it is believed that postoperative cooling of the grafts with cold saline compresses may enhance survival. The upper limit of size for graft survival is thought to be about 1.0 to 1.5 cm. No data has been found regarding the use of hyperbaric oxygen (HBO) for composite grafts to the nose.