Locoregional flaps versus skin grafts in the nose: aesthetic considerations after cancer ablation

Abstract

Background The annual incidence of skin cancer has been increasing, and surgical ablation is presently the treatment of choice for skin cancer. However, it leaves soft tissue defects that require reconstruction. The methods for reconstruction include locoregional flaps (LRFs) and full-thickness skin grafts (FTSGs). We compared these two surgical methods for reconstruction of defects in the nose, which is prominently visible and the most common site of facial skin cancer, and assessed the cosmetic results by evaluating the scars.Methods This retrospective study was conducted between July 2012 and January 2021. Patients were evaluated for scars after at least 6 months of follow-up. Patients were divided into LRF and FTSG groups. The scars were evaluated using the Vancouver Scar Scale.Results In total, 27 patients were included in this study. Their mean age was 66.8 years. Eighteen patients underwent LRF, and nine patients underwent FTSG. The average defect size was 1.55 cm² in the LRF group, and 1.38 cm² in the FTSG group. The average scar score was 1.44 points in the LRF group and 3.67 points in the FTSG group. The LRF group showed significantly lower total scores than the FTSG group.Conclusions Although LRFs and FTSGs are useful reconstructive methods for nasal soft tissue defects, this study showed that LRFs are superior to FTSGs in terms of aesthetic results.

Using Integra for Reconstruction of Facial Defects after Mohs Micrographic Surgery

“…A loss of dermis has been known to result in severe scarring and contracture, and can be accentuated by wound healing issues, tension, or any type of flap necrosis. [24][25][26] Although FTSGs do incorporate a small portion of dermis, increasing wound depth can cause irregular graft take and recurrent contracture, but large wounds over bone or cartilage are prone to failure. 27,28 It is likely for this reason, in addition to better regionally-matched skin color, that LRFs have been shown to have a statistically significant advantage in observer-rated scar scoring when compared with single-stage FTSGs.…”

“… 27 , 28 It is likely for this reason, in addition to better regionally-matched skin color, that LRFs have been shown to have a statistically significant advantage in observer-rated scar scoring when compared with single-stage FTSGs. 26 The dermal regenerative properties of Integra help address this issue by primarily promoting granulation tissue at the base of dermal defect, which thereby aids in the avoidance of wound depth discrepancies and subsequent contracture. 6 With its additional ability to generate neodermis on both exposed bone and cartilage, while also minimizing bacterial invasion, it is not surprising that reoperation rates were low for both single and dual-stage reconstructions performed with Integra [9% (5/58) versus 17% (13/78)].…”

“…The face is a difficult area to achieve aesthetic reconstruction to begin with due to the variable topography, surface contours, and symmetry created by the major facial structures and landmarks. 26 LRFs may provide donor tissue with comparable skin color and contour, but Integra has also shown its capability of re-pigmenting and re-epithelializing well to surrounding tissue. 29 , 30 Aside from patient preference, this could be one of the reasons why patients who received dual-stage reconstruction with skin graft underwent more aesthetic interventions (17% versus 9%) than those who received single-stage Integra reconstruction alone.…”