Tissue Deficiency between Tip and Ala

A 15-year-old female patient presented with isolated congenital cleft in medial half of left ala. On examination, there was tissue deficiency between tip and ala, deficient and abnormally placed lower lateral cartilage and atrophic oblique ala. Systemic examination of face and other organ systems revealed no other anomalies. Surgery was performed under general anesthesia with orotracheal intubation. A template was made from normal side and used for planning in reverse to determine the dimension and design of extra skin to be incorporated in transposition flap. A transverse line was drawn from normal side of columella to determine the exact position of tip of flap. A “V” shaped incision was made to prevent notching at suture line. Alar flap was strengthened with a conchal cartilage graft from midline to alar base crossing the suture line. Donor defect was covered with chondrocutanous graft harvested from Lt. concha. Graft was successfully taken up and defect minimized by Dr Navin Shukla. patient was very happy as well as more cosmetically confident after 3 months.