Skin Grafts vs Local Flaps for Reconstruction of Nasal Defects

Abstract

IMPORTANCE Nasal defects commonly are a result of removal of skin lesions, and reconstruction presents a cosmetic challenge to surgeons. Conventional thought and study results have held that cosmetic outcomes of local flap reconstructions may be superior to those of skin grafts. However, local flap reconstructions require more adjunctive procedures. We propose that in select cases, skin grafts can provide aesthetic outcomes equal to those of local flaps with fewer adjunctive procedures. OBJECTIVE To evaluate the cosmetic outcomes of skin grafts vs local flaps in the reconstruction of nasal defects. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective review of medical records for 103 patients who underwent nasal reconstruction with either skin graft (n=39) or local flap (n=64) between 2005 and 2013. All patients were treated by a single surgeon at an academic medical institution. Patients who had defects larger than 30 × 35 mm or a history of adjacent reconstruction that would detract from the cosmetic outcome of the procedure under analysis were excluded. MAIN OUTCOMES AND MEASURES Cosmetic outcome was graded using a visual analog scale (VAS) score based on an ordinal 5-point Likert scale (1, excellent; 5, poor) by 4 independent raters blinded to reconstruction technique. Information was collected regarding patient demographics, defect size, pathology, type of reconstruction, and any postoperative procedures performed. RESULTS The mean VAS score for the skin graft group was 2.18, while the mean score for the flap group was 2.12 (P = .43). The 39 patients with graft reconstruction had a total of 11 triamcinolone acetonide injections and 8 dermabrasion sessions postoperatively. The 64 patients with local flap reconstruction had a total of 259 triamcinolone acetonide injections and 13 dermabrasion sessions postoperatively plus 39 additional staged surgical procedures. CONCLUSIONS AND RELEVANCE Skin grafts are a valuable reconstructive option that provide aesthetic outcomes comparable to those of local flap procedures and with less need for additional postoperative interventions in properly selected nasal defects. LEVEL OF EVIDENCE 3.

Fibrin Glue and Autologous Split-Thickness Skin Graft after Facial Skin Cancer Resection

“…Reconstruction of facial defects resulting from resection of malignant tumors by Mohs microsurgery [17] is best accomplished with either local or regional flaps adapted to the anatomic site and extent of resection. When such flaps are difficult to implement due to comorbidities and/or risk of functional injury, autologous free skin graft transfer is a valuable alternative [16,[19][20][21][22][23]. In the case of Mr. A, his prior ipsilateral parotidectomy, exposure of the perilesional tissues to radiation therapy, and potential risk of damage to facial nerve branches were relative contraindications to locoregional flap reconstruction.…”

Reconstruction of nasal defects: contemporary approaches

“…However, this may be related to the process of selection. In a recent paper by Sapthavee, Munaretto, and Toriumi, the authors reviewed the results of 103 patients who underwent nasal reconstruction with either a full-thickness skin graft or local flap for defects less than 30 × 35 mm [21**]. Skin grafts provided aesthetic outcomes comparable to those of local flap procedures in properly selected nasal defects.…”

State-of-the-art reconstruction of midface and facial deformities

“…Reconstruction of rhinectomy defects is best performed with separate flaps from those used for maxillary and cheek reconstruction. Smaller defects are best reconstructed with local flaps, skin grafts, or paramedian foreheads flaps, and routinely yield excellent results [22][23]. However, more extensive rhinectomy defects that require internal lining, cartilaginous or bony support, and external coverage often requires an extended number of operations in order to obtain the most optimal result.…”