The perichondrial cutaneous graft: a facial reconstructive option for the ages (ages 1 week to 94 years).

Objectives/hypothesis: The perichondrial cutaneous graft (PCCG) possesses unique characteristics that make them a propitious reconstructive option in facial plastic surgery. The PCCG is easily harvested from the conchal bowl. Notable characteristics are that it does not contract, unexcelled color match for resurfacing facial skin, and minimal donor site morbidity. This free graft frequently offers an expeditious solution to an otherwise more complicated reconstructive effort.

Study Design: Retrospective review of an academic otolaryngology and facial plastic surgery practice.

Methods: : Patients requiring head and neck reconstruction for cutaneous deficiencies were studied. The PCCG is harvested from the anterior conchal bowl. This is technically easy, and the perichondrium is tightly adherent to the dermis in this area. The donor site is closed by resecting a fenestra of conchal cartilage and rotating a posterior auricular interpolated island flap into the defect (the "flip-flop-flap"). The posterior auricular defect is easily closed in a linear fashion. The main outcome measures were cosmetic result, graft survival, donor site morbidity, and complications.

Results: There are 406 PCCGs in our series. Patients ranged in age from 7 days to 94 years. There were 170 grafts used for trauma and 236 used for reconstruction after skin cancer resection. Over the past 30 years in observing these grafts, there are no contractions noted in infants and children, growth with maturity is noteworthy. Cosmesis is excellent and in most cases superior to other skin grafting techniques. We have had four total failures and six partial losses of less than 30% for the PCCG. All complete failures were in patients with a smoking history.

Conclusions: The PCCG is a very reliable flap for reconstruction of facial defects. It has been used in elderly and heavy smoking patients with minimal complications, attesting to its viability. The graft provides excellent cosmesis and it is an expeditious alternative to commonly used local flaps. It is especially useful in pediatric patients because the graft actually expands with growth. This is in contrast to the disadvantages of split thickness and full thickness skin grafts that predictably contract with maturity. Local flaps often lack adequate laxity for common implementation and make the PCCG a propitious choice in the pediatric patient.