Free Cartilage Grafts and Healing by Secondary Intention: A Viable Reconstructive Combination After Excision of Nonmelanoma Skin Cancer in the Nasal Alar Region
Abstract
To assess the feasibility and outcome of free cartilage grafts left to heal by secondary intention in the reconstruction of nasal alar skin defects. We describe the retrospective analysis of 13 patients who were treated in a single department with the use of free cartilage grafts in combination with secondary intention healing for reconstruction of the alar subunit and lateral nasal wall defects after Mohs surgery for cutaneous cancer. Outcome measures included patient and surgeon satisfaction, alar retraction, cartilage extrusion, nasal valve collapse, revision rate, and time to healing. All wounds healed uneventfully by secondary intention, and the results were gauged as at least satisfactory by the patient and the surgeon. In 3 patients, minor aesthetic faults were evident; in 1 patient, the underlying cartilage was prominent and a hypertrophic scar also developed; in 1 patient, there was some alar notching; and in 1 other patient, a hypertrophic scar developed. One patient had a functional complaint of nasal blockage on the side that was surgically treated. Free cartilage implants in combination with secondary intention healing is a relatively simple, cost-effective, 1-stage technique. Our results demonstrate that this alternative reconstructive method is a viable option for small and deep defects of the alar subunit and the nasal sidewall of the nose. The donor site morbidity is limited to the ear.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Cites
The Subunit Principle in Nasal Reconstruction
Burget, G. C., & Menick, F. J. (1985) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-198508000-00010 · Cited by 862 · see citing works
Kelleners-Smeets, N. W. J., Krekels, G. A. M., Ostertag, J. U., Essers, B. A. B., Dirksen, C. D., Nieman, F. H. M., & Neumann, H. A. M. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17399-6 · Cited by 365 · see citing works
Kelleners-Smeets, N. W. J., Kuijpers, D. I. M., Nelemans, P. J., Ostertag, J. U., Verhaegh, M. E. J. M., Krekels, G. A. M., & Neumann, H. A. M. (2004) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2004.06047.x · Cited by 267 · see citing works
Wound healing by secondary intention
Zitelli, J. A. (1983) · Journal of the American Academy of Dermatology · doi:10.1016/s0190-9622(83)70150-7 · Cited by 260 · see citing works
Nasal Reconstruction???Beyond Aesthetic Subunits: A 15-Year Review of 1334 Cases
Rohrich, R. J., Griffin, J. R., Ansari, M., Beran, S. J., & Potter, J. K. (2004) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000138596.57393.05 · Cited by 253 · see citing works
Accelerated Healing of Full-Thickness Skin Wounds in a Wet Environment
Svensjö, T., Pomahač, B., Yao, F., Sláma, J., & Eriksson, E. K. (2000) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-200009030-00012 · Cited by 181 · see citing works
Accelerated Healing of Full-Thickness Skin Wounds in a Wet Environment
Svensjö, T., Pomahač, B., Yao, F., Sláma, J., & Eriksson, E. K. (2000) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-200009010-00012 · Cited by 176 · see citing works
Recurrent Basal Cell Carcinoma
Koplin, L. M., & Zarem, H. A. (1980) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-198005000-00017 · Cited by 172 · see citing works
Aesthetic Restoration of the Nose
Burget, G. C. (1985) · Clinics in Plastic Surgery · doi:10.1016/s0094-1298(20)31673-4 · Cited by 154 · see citing works
Secondary intention healing: An alternative to surgical repair
Zitelli, J. A. (1984) · Clinics in Dermatology · doi:10.1016/0738-081x(84)90031-2 · Cited by 148 · see citing works
van der Eerden, P. A., Lohuis, P. J. F. M., Hart, A. A. M., Mulder, W., & Vuyk, H. D. (2008) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e31818a9aaa · Cited by 77 · see citing works
Self-citationMohs micrographic surgery for facial skin cancer
Vuyk, H. D., & Lohuis, P. J. F. M. (2001) · Clinical Otolaryngology · doi:10.1046/j.1365-2273.2001.00484.x · Cited by 76 · see citing works
Snow, S. N., Stiff, M. A., Bullen, R., Mohs, F. E., & Chao, W.-H. (1994) · Journal of the American Academy of Dermatology · doi:10.1016/s0190-9622(94)70209-8 · Cited by 73 · see citing works
Healing by secondary intention of auricular defects after Mohs surgery
Levin, B. C., Adams, L. A., & Becker, G. D. (1996) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.1996.01890130051008 · Cited by 65 · see citing works
Nasal Valve Malfunction Resulting From Resection of Cancer
Robinson, J. K., & Burget, G. C. (1990) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.1990.01870120065011 · Cited by 64 · see citing works
Li, S., Cao, W., Cheng, K., Yin, C., Qian, Y., Cao, Y., & Chang, T.-S. (2006) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2006.03.050 · Cited by 40 · see citing works
Cancer of the Skin of the Nose
Conley, J. (1974) · Annals of Otology Rhinology & Laryngology · doi:10.1177/000348947408300102 · Cited by 36 · see citing works
Perichondrial Cutaneous Graft: An Alternative in Composite Skin Grafting
Portuese, W., Stucker, F., Grafton, W. D., Shockley, W., & Gage‐White, L. (1989) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.1989.01860300059017 · Cited by 32 · see citing works
Choice of Wound Dressings and Ointments
Brown, C. D., & Zitelli, J. A. (1995) · Otolaryngologic Clinics of North America · doi:10.1016/s0030-6665(20)30477-1 · Cited by 26 · see citing works
Surgical treatment of skin cancer of the nose
Bennett, J. E., Moore, T. S., Jr., Vellios, F., & Hugo, N. E. (1969) · The American Journal of Surgery · doi:10.1016/0002-9610(69)90375-4 · Cited by 15 · see citing works
Modern dressings: healing surgical wounds by secondary intention
Dziewulski, P. G., James, S. E., Taylor, D. G., Bosanquet, N., CUTTING, K. F., & West, P. A. (2003) · Hospital Medicine · doi:10.12968/hosp.2003.64.9.2248 · Cited by 14 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Ear Reconstruction after Mohs cancer excision: lessons learned from 327 consecutive cases
Sanniec, K., Harirah, M., & Thornton, J. F. (2019) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000005992 · Cited by 39 · see citing works
Cartilage Grafting in Nasal Reconstruction
Immerman, S. B., White, W. M., & Constantinides, M. S. (2010) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2010.10.006 · Cited by 34 · see citing works
Secondary Intention Healing After Mohs Surgical Excision as an Alternative to Surgical Repair
Liu, K. Y., Silvestri, B., Marquez, J., & Huston, T. L. (2020) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000002330 · Cited by 29 · see citing works
Zopf, D. A., Iams, W. T., Kim, J. C., Baker, S. R., & Moyer, J. S. (2013) · JAMA Facial Plastic Surgery · doi:10.1001/2013.jamafacial.25 · Cited by 26 · see citing works
Second-intention healing of nasal alar defects.
Neuhaus, I., & Yu, S. S. (2012) · Dermatologic Surgery · doi:10.1111/j.1524-4725.2011.02233.x · Cited by 19 · see citing works
Arden, R. L., & Miguel, G. S. (2012) · The Laryngoscope · doi:10.1002/lary.23377 · Cited by 19 · see citing works
Zopf, D. A., Iams, W. T., Kim, J. C., Baker, S. R., & Moyer, J. S. (2012) · JAMA Facial Plastic Surgery · doi:10.1001/jamafacial.2013.25 · Cited by 18 · see citing works
Kim, D. J., Makdisi, J., Regan, C. M., Chen, P., Chao, E., & Rotunda, A. M. (2020) · Dermatologic Surgery · doi:10.1097/dss.0000000000002714 · Cited by 16 · see citing works
Sekundäre Wundheilung nach tumorchirurgischen Eingriffen im Kopf-Hals-Bereich
Bechara, F. G. (2013) · Der Hautarzt · doi:10.1007/s00105-013-2540-2 · Cited by 14 · see citing works
Image-Guided Titanium Implantation for Craniofacial Prosthetics
Meltzer, N. E., Garcia, J. R., Byrne, P. J., & Boahene, D. K. O. (2009) · Archives of Facial Plastic Surgery · doi:10.1001/archfaci.2008.510 · Cited by 13 · see citing works
One-stage reconstruction of full-thickness alar defects with a folded nasolabial island flap
Lee, D. W., Ryu, H. R., Choi, H. J., & Kim, J. H. (2021) · Archives of Craniofacial Surgery · doi:10.7181/acfs.2021.00339 · Cited by 11 · see citing works
Secondary Intention Healing of Nasal Ala and Tip Defects: A Simple and Valuable Treatment Option
Wen, G., Mao, D., Zhu, M., Hu, J. S., Yao, X., & Zhang, J. (2022) · Clinical Cosmetic and Investigational Dermatology · doi:10.2147/ccid.s361662 · Cited by 10 · see citing works
Timmermans, A. J., Brandsma, D., Smeele, L. E., Rosingh, A., van den Brekel, M. W. M., & Lohuis, P. J. F. M. (2013) · Annals of Otology Rhinology & Laryngology · doi:10.1177/000348941312200410 · Cited by 10 · see citing works
Key issues in nasal reconstruction
Asaria, J., Pepper, J., & Baker, S. R. (2010) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0b013e32833af8f8 · Cited by 10 · see citing works
Free Cartilage Batten Graft With Second Intention Healing to Repair a Full-Thickness Alar Wound
Rotunda, A. M., & Cabral, E. S. (2014) · Dermatologic Surgery · doi:10.1097/01.dss.0000452633.29705.09 · Cited by 9 · see citing works
Gil‐Lianes, J., Martí‐Martí, I., & Morgado‐Carrasco, D. (2025) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2024.09.024 · Cited by 7 · see citing works
Repair of a Large Multisubunit Nasal Defect
Shin, T. M., & Bordeaux, J. S. (2016) · Dermatologic Surgery · doi:10.1097/dss.0000000000000516 · Cited by 6 · see citing works
Schäfer, K., Rudolph, C., Cotofana, S. C., Goebeler, M., & Weyandt, G. H. (2018) · Dermatology · doi:10.1159/000490907 · Cited by 6 · see citing works
Surgical Techniques Following Free Cartilage Grafting
Hill, S. T., Delost, R. L., Wee, C. E., Long, T. C., Bordeaux, J. S., & Scott, J. F. (2022) · Dermatologic Surgery · doi:10.1097/dss.0000000000003534 · Cited by 4 · see citing works
Dermatochirurgie – Tricks of the Trade / Dermatosurgery – Tricks of the Trade
Monari, P., Damiani, C., Ariasi, C., Rovaris, S., & Calzavara‐Pinton, P. (2023) · JDDG Journal der Deutschen Dermatologischen Gesellschaft · doi:10.1111/ddg.15173 · Cited by 3 · see citing works
Leser-Trélat sign: does it really exist?
Ascari-Raccagni, A., Dondas, A., Meo, N. D., & Trevisan, G. (2013) · PubMed · Cited by 3 · see citing works
Jackson, S. M., & Reisler, T. (2018) · Europe PMC (PubMed Central) · Cited by 3 · see citing works
The challenge of composite graft: the use of fluorescent light energy to improve engraftment
Amabile, A., L’Erario, S., Scarpa, C., Vindigni, V., Bassetto, F., & Marena, F. (2024) · Case Reports in Plastic Surgery and Hand Surgery · doi:10.1080/23320885.2024.2396946 · Cited by 2 · see citing works
How We Do It: Buried Cartilage Grafts to Assist in Autologous Skin Grafting
SALMON, P. J., MORTIMER, N. J., & Aronson, A. (2021) · Dermatologic Surgery · doi:10.1097/dss.0000000000003271 · Cited by 2 · see citing works
Reconstrução dos defeitos nasais após exérese de tumores pela cirurgia micrográfica de Mohs
Padoveze, E. H., & Cernea, S. S. (2013) · Redalyc (Universidad Autónoma del Estado de México) · Cited by 1 · see citing works
Pendem, S., & SRIPATHI, V. (2022) · Otorhinolaryngology · doi:10.23736/s2724-6302.22.02420-3 · Cited by 1 · see citing works
Surgical Reconstruction of Nasal Alar Deformities
Kim, M. S., & Choi, J. Y. (2017) · Journal of rhinology · doi:10.18787/jr.2017.24.2.65 · Cited by 1 · see citing works
Salim, H. A., & Munawah, B. (2013) · Al-Rafidain dental journal/Maǧallaẗ al-rāfidayn li-ṭibb al-asnān · doi:10.33899/rden.2020.165388 · Cited by 1 · see citing works
Hjorth, M. K., Burian, E. A., Glud, M., Mogensen, M., Karlsmark, T., & Karmisholt, K. E. (2021) · Skin Research and Technology · doi:10.1111/srt.13024 · Cited by 1 · see citing works
Tasman, A. (2009) · Springer eBooks · doi:10.1007/978-3-642-05010-7_1 · Cited by 1 · see citing works
Ear Reconstruction following Mohs Micrographic Surgery
Mohan, V. C., Owens, W. R., Schmidt, J. L., Burns, H. R., & Buchanan, E. P. (2024) · Seminars in Plastic Surgery · doi:10.1055/s-0044-1791830
Reconstruction: Flaps, Grafts, and Other Closures
Martinez-Diaz, G., & Gladstone, H. (2012) · Springer eBooks · doi:10.1007/978-0-387-09424-3_8
Commentary: Commentary for Secondary Intention Healing of Nasal Alar Defects
Humphreys, T. R. (2012) · Dermatologic Surgery · doi:10.1111/j.1524-4725.2012.02371.x
Prevention of Undesirable Outcomes
Golda, N. J., Brown, B., Basak, A., Potter, K. A., & Kohli, N. (2019) · Springer eBooks · doi:10.1007/978-3-030-02023-1_66
Shin, D. M., Choi, K. S., Ahn, P. A., & Jung, Y. G. (2019) · Journal of Clinical Otolaryngology Head and Neck Surgery · doi:10.35420/jcohns.2019.30.2.247
Revision Repair of a Collapsed External Nasal Valve
Croley, J. A., Malone, C. H., Wagner, R. F., & Munavalli, G. S. (2022) · Dermatologic Surgery · doi:10.1097/dss.0000000000003221
3 Reconstruction of the Nasal Unit
(2023) · Haug Verlag in Georg Thieme Verlag KG eBooks · doi:10.1055/b-0043-196650
Rekonstruktion eines durchgehenden Nasenflügeldefekts mit gefaltetem Nasolabiallappen
Monari, P., Damiani, C., Ariasi, C., Rovaris, S., & Calzavara‐Pinton, P. (2023) · JDDG Journal der Deutschen Dermatologischen Gesellschaft · doi:10.1111/ddg.15173_g
Gil‐Lianes, J., Martí‐Martí, I., & Morgado‐Carrasco, D. (2025) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2025.02.021
Takeshita, A., Matsunaga, K., Morita, Y., Matsumiya, Y., Okumura, M., Sakake, H., & Uzawa, N. (2025) · Journal of Stomatology Oral and Maxillofacial Surgery · doi:10.1016/j.jormas.2025.102417
Acosta, Á. E., Aasi, S. Z., MacNeal, R. J., MESSINGHAM, M. J., & Arpey, C. J. (2015) · Elsevier eBooks · doi:10.1016/b978-0-323-26027-5.00019-x
Hjorth, M. K., Burian, E. A., Karlsmark, T., Mogensen, M., Glud, M., Harager, A., Rossi, A., & Karmisholt, K. E. (2026) · Acta Dermato Venereologica · doi:10.2340/actadv.v106.43586
Nasal Alar Subunit Reconstruction: A Review of Data
Menapace, D. C., Shockley, W. W., Miller, M., & Clark, J. M. (2026) · Laryngoscope Investigative Otolaryngology · doi:10.1002/lio2.70494
- Authors
- van der Eerden, P. A., Verdam, F. J., Dennis, S. C. R., & Vuyk, H.
- Affiliations
- Department of Otolaryngology, Lange Land Hospital, Zoetermeer, the Netherlands (Dr van der Erden); Department of Surgery, Amphia Hospital, Breda, the Netherlands (Dr Verdam); Department of Otolaryngology, Queen Alexandra Hospital, Portsmouth, England (Dr Dennis); and Department of Otolaryngology and Facial Plastic Surgery, Gooi-Noord Hospital, Blaricum, the Netherlands (Dr Vuyk).
- Queen Alexandra Hospital (GB)
- ORCID
- Verdam, Froukje J.
- Venue
- Archives of Facial Plastic Surgery
- Publisher
- SAGE Publications
- Published
- 2009-01-01
- Volume
- 11
- Issue
- 1
- Pages
- 18-23
- ISSN
- 1521-2491 (ISSN-L)
- 1538-3660
- OpenAlex
- W2116970189
- Cited by
- 44
- References
- 21
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 6 · 2012: 3
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Facial Plastic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Health Sciences › Medicine › Surgery › Head and Neck Surgical Oncology
- Keywords
- secondary intention healing, Mohs micrographic surgery, skin cancer, hypertrophic scars, nasal valve collapse, donor site morbidity, nasal reconstruction
- MeSH terms
- Adult, Aged, Aged, 80 and over, Carcinoma, Basal Cell, Basal Cell Carcinoma, Cartilage, Feasibility Studies, Female, Humans, Male, Middle Aged, Nose, Retrospective Studies, Skin Neoplasms, Wound Healing, Wounds and Injuries, Mohs Surgery, Treatment Outcome, Plastic Surgery Procedures
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
