Fenestration of auricular cartilage grafts to aid healing of alar wounds by secondary intention

Alar reconstruction should follow the principles of cosmetic subunits for nasal reconstruction,1 so defects that affect multiple subunits (Fig. 1) should be converted into a single alar defect (Fig. 2). The contralateral ala is used as the template to recreate a symmetrical and appropriately positioned alar groove. The purpose of the cartilage graft is twofold: to preserve the patency of the internal valve, and to prevent contraction caused by the formation of granulation tissue during healing. Patency of the nasal valve may be assessed using the Cottle test,2 and from observing the nostrils from below (preoperatively).

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