Columellar reconstruction in children

Defects of the nasal complex can cause significant functional and psychosocial impairment. Nasal reconstruction aims to restore the normal trilaminar structure of the nose, which includes the internal lining, cartilaginous framework, and soft tissue envelope. Among the nasal subunits, the columella is especially challenging to reconstruct due to its unique contour and composite nature. Multiple techniques have been described, each carrying distinct advantages and disadvantages; however, the optimal procedure for an isolated defect of the columella remains elusive. The ideal reconstructive technique should recreate the contour of the columella, provide nasal tip projection, and maintain external valve patency. Additional considerations include matching the pigmentation and texture of the nasal skin while minimizing donor site morbidity. The authors recommend a 2-stage reconstruction with bilateral nasal sill flaps and an auricular composite graft.