Two-layered, composite grafts from the ear are versatile grafts for full-thickness defects of the lower third of the nose. The 2-layered composite grafts can be tenuous because of their marginal blood supply and the reduced contact surface between graft skin and recipient site. Rees first described the use of composite auricular grafts in 1960 with an initial graft survival rate of 53%. Important variables for maximizing reliability and survival are thorough, careful preoperative preparation, including recognition of adverse patient factors; meticulous surgical techniques; and diligent postoperative care.
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