Full-thickness skin grafts for surgical defects of the nasal ala - a comprehensive review, approach and outcomes of 186 cases over 9 years

Abstract

SummaryBackground Skin cancers of the nasal ala are commonly encountered in dermatological surgery. Various techniques have been described to reconstruct surgical defects of the ala, including melolabial transposition flaps, interpolated melolabial flaps, bilobed and trilobed transposition flaps, island pedicle flaps and spiral flaps. Full-thickness skin grafts have received little attention in the reconstructive literature.Objectives We present our experience with full-thickness skin grafts for the reconstruction of partial thickness defects of the nasal ala in the largest series to date. Methods A retrospective analysis of the Mohs micrographic surgery database over a 9-year period was performed. All cases of full-thickness skin grafts for reconstruction of the nasal ala were identified. Defect location, size and any postoperative complications were noted. All patients were reviewed at the time of suture removal, at 3 and 6 weeks postoperatively and at 1 year. Results There were 186 cases in total in 181 patients (88 men and 93 women). Their ages ranged from 31 to 88 years with a mean of 65 years (median 66). Defect size varied from 0Á3 9 0Á4 cm to 2Á0 9 2Á7 cm, with the average defect size measuring 1Á0-1Á2 cm in diameter. Thirty-six per cent (67 of 186) of cases underwent postoperative dermabrasion, and 8% (14 of 186) received postoperative intralesional triamcinolone. The incidence of graft failure and infection was low. Good-to-excellent cosmetic results were seen in all patients and postoperative complications were uncommon and minor. Conclusions The use of full-thickness skin grafts for defects of the nasal ala is a simple and versatile reconstructive option with excellent functional and aesthetic outcomes.

Logarithmic Spiral Flap for Circular or Oval Defects on the Lateral Surface of the Nose and Nasal Ala: A Series of 15 Cases

“…In a series of 168 patients with small defects on the nasal ala that were reconstructed with full-thickness skin grafts, 93 required an intervention to improve the cosmetic appearance: 67 by triamcinolone acetonide injection, 14 by a combination of triamcinolone injections and laser, and 12 by laser alone. 3 The Limberg and Dufourmentel transposition flap is useful to cover geometric rhomboid defects, but it is not so effective in round or oval defects. 4 Digitiform and lobed flaps that transpose adjacent skin frequently produce lumps, with a very unsightly trap-door effect.…”

Reconstruction of nasal defects: contemporary approaches

“…Although not typically thought of as an ideal site for skin grafts, Tan, Mortimer and Salmon reviewed their case series of 186 full-thickness skin grafts for surgical defects of the nasal ala [22]. The average defect diameter was 1.0–1.2 cm.…”

Comparing Skin Grafts Harvested From Wrist With Those Harvested From Groin Region in Patients With Fingertip Injury: A Randomized Clinical Trial

“…For evaluation of TPD, we used paper clips (DellonMcKinnon Disk-Criminator, Fabrication Enterprises Inc, White Plains, New York, USA) fixed in definite distances (2,3,4,5,6,7,8, and 9 mm) ( Figure 1) (8).…”

“…When skin loss is more than half of the pulp size, coverage with skin graft leads to faster recovery with less morbidity (1). Full-thickness skin grafts supply better protection and sensation as well as less contracture than split thickness skin graft does (1,(3)(4)(5). The goal is performing full thickness skin graft from inconspicuous donor sites that provide an excellent clinical and photographic match in terms of color, texture, thickness, and sebaceous quality.…”