The cartilaginous and bony framework of the nose is enveloped by the external covering skin and internal lining. This framework supports and shapes soft tissues and braces a reconstructed nose against gravity, tension, and scar contraction. If missing, nasal support must be replaced. The dimension, border outline, and shape of these bone and cartilage support grafts will re-establish the normal nasal contour.
Primary cartilage support grafts are placed as necessary in all areas where the underlying, normal residual nasal lining remains intact. But, normally no cartilage is placed in the area of forehead flap folding because it is difficult to position, fix, and design grafts in that area.
The choice of donor material will depend on the needs of the defect:
- Graft size
- Graft shape
- Graft rigidity
Septal cartilage is straight but of limited length and thickness.
Ear cartilage is relatively soft, curved, but limited in availability.
Rib cartilage is available in large quantity, thickness, has rigidity, and can be shaved into thinner more bendable strips with suture material.
Grafts are fixed with sutures to remaining nasal support structures and fixed to one another to recreate a rigid nasal framework to support and shape the nose.