Usefulness of full-thickness skin grafting from the infraclavicular area for facial reconstruction

Abstract

Background: Full-thickness skin grafts (FTSGs) have been widely used after facial skin cancer resection, for correcting defects that are too wide to be reconstructed using a local flap or if structural deformation is expected. The preauricular, posterior auricular, supraclavicular, conchal bowl, nasolabial fold, and upper eyelid skin areas are known as the main donor sites for facial FTSG. Herein, we aimed to describe the effectiveness of using infraclavicular skin as the donor site for specific cases. Methods: We performed FTSG using the infraclavicular skin as the donor site in older Asian adults following skin cancer resection. Outcomes were observed for > 6 months postoperatively. The Manchester Scar Scale was used for an objective evaluation of satisfaction following surgery and scarring. Results: We analyzed the data of 17 patients. During follow-up, the donor and recipient sites of all patients healed without complications. Upon evaluation, the average Manchester Scar Scale scores for the recipient and donor sites were 7.4 points and 5.7 points, respectively. Conclusion: In general, conventional donor sites, such as the preauricular, posterior auricular, and supraclavicular sites, are widely used for facial FTSG because they achieve good cosmetic results. However, the infraclavicular skin may be a useful donor for facial FTSG in cases where the duration of time spent under anesthesia must be minimized due to a patient's advanced age or underlying health conditions, or when the recipient site is relatively thick area, such as the nose, forehead, or cheek.

Extended Scalp Reconstruction With a Free Supraclavicular Graft: A Case Report

“…Excision of skin lesions may require restoration either with local flaps or skin grafts to achieve a decent cosmetic and functional outcome [ 6 ]. The most common donor areas to cover skin defects of the head and neck area are the posterior auricular skin, the preauricular skin, the nasolabial fold, the forearm, the thigh, the major pectoralis muscle, and the abdominal area [ 1 , 3 , 7 , 8 ]. The supraclavicular area is gaining ground in tissue reconstruction and restoration of small and large deficits [ 9 ].…”

“…The supraclavicular area is gaining ground in tissue reconstruction and restoration of small and large deficits [ 9 ]. According to some authors, it offers a lower failure rate due to its thinner size [ 3 ].…”

“…The success of a skin graft surgery is strongly related to the choice of the most appropriate donor site. The recipient site's specific characteristics should be considered to make the proper decision [ 1 , 3 ]. A split-thickness graft could be expanded in case of a large deficit, offering better adherence on the surgical bed but a less favorable aesthetic outcome [ 1 ].…”

“…Grafts are either full thickness containing all skin layers above the subcutaneous tissue, or split-thickness consisting only of the epidermis and a part of the dermis [ 2 ]. Thorough consideration of skin color, thickness, and consistency is required to decide the most suitable donor site [ 1 , 3 ]. The most commonly used free grafts for head and neck reconstruction are derived from the major pectoralis muscle, the forearm, and the face [ 3 , 4 ].…”

“…Thorough consideration of skin color, thickness, and consistency is required to decide the most suitable donor site [ 1 , 3 ]. The most commonly used free grafts for head and neck reconstruction are derived from the major pectoralis muscle, the forearm, and the face [ 3 , 4 ]. The supraclavicular area is also a reliable donor option to cover large head and neck defects due to its similarity in color, thickness, and flexibility [ 4 ].…”