Auricular composite graft for skin defect of the philtrum dimple.

Our method of performing an auricular composite graft for a skin defect of the philtrum dimple in a patient whose lip is not damaged and has retained its original softness and elasticity is presented. After resecting the lesion, an auricular composite graft is harvested from the conchal region. The size of the graft is almost the same as the size of the resected lesion, although the cartilage is harvested in an elliptical shape, and its size is approximately 60% in area of the overriding skin of the graft. The graft is harvested from the site, which has a similar curvature to the defect. The cartilage is sutured tightly to the graft bed at a minimum of four points with 6-0 absorbable suture. The transversal axis of the harvested cartilage is sutured as vertically as possible so as to fit the direction of the wrinkle line of the upper lip. The skin is sutured to the defect margin using 5-0 nylon suture. The graft donor site is closed primarily. This method has been used for the closure of six comparatively large skin defects after resecting a skin lesion (pigmented nevus in three cases and hypertrophic scar in three cases) in the philtrum dimple in six patients. In all cases, the upper lip was not damaged and retained its original softness and elasticity. The "take" of the graft was complete in all patients, and the donor site healed without any problem. In all cases, postoperative shrinkage of the graft was not significant during the follow-up period, and the graft had a smooth surface. In addition, no patients suffered from a feeling of discomfort in moving the mouth, and an acceptable shape of the philtrum dimple was achieved in all cases. There were no deformational changes in the graft donor site. In conclusion, our method is valid in the patient whose lip is not damaged and has retained its original softness and elasticity and in whom a full-thickness skin graft is selected as the covering method for a skin defect of the philtrum dimple.