The contribution of a dermal substitute in the three-layers reconstruction of a nose tip avulsion.

Through and through defects of the nasal ala still remains debated challenge in plastic reconstructive surgery. We present a 36 y.o. woman who suffered by a through and through nose tip avulsion subsequently a dog bite. She refused the use of traditional auricular composite graft or the multiple stages midline forehead flap due to the secondary visible scars. We treated her with the combined use of mucoperichondrial septal flap, cartilage graft and dermal substitute Integra graft, followed by a secondary, full-thickness skin graft. We consider the Integra(®) as a useful option for the treatment of a complex trauma of the nose with through and through tip and alar avulsion when, due to scar or consent problem, it's not possible the use of other techniques.