H. G. Schwartzberg1, A. Yoo1, G. Mundinger3, J. Lindsey2, S. Maddox1, C. Dupin1 1Louisiana State University Health Sciences Center, Plastic Surgery, New Orleans, LA, USA 2Nuvance Health Department of Surgery, General Surgery, Poughkeepsie, NEW YORK, USA 3The Crane center for Transgender Surgery, Austin, TEXAS, USA
Introduction:
Nasal defects are notoriously difficult to reconstruct aesthetically. Traditionally nasal defects have been reconstructed via local and regional flaps. However, these options involve considerable donor site morbidity, and inconvienance for patients. Additionally, many of these methods involve multiple surgeries increasing the overall morbidity and opportunity for complications. Skin grafting typically has few indications in nasal reconstruction; however, it involves little donor site risk. Previous studies have described full thickness skin grafts (FTSGs) from various sites for small defects involving the upper 2/3 of the nose. In our study we propose use of a FTSG from the widow’s peak area of the forehead rather than the commonly used periauricular skin. In the author’s experience this donor site has a color match, contour and thickness which is more similar to the surrounding nasal soft tissue when compared to periauricular FTSGs. This study aims to further explore the use of FTSGs from the forehead to reconstruct defects throughout the nose.
Methods:
Following institutional board review (IRB) a retrospective chart review was conducted including procedures that were conducted from 2014-2019 by a single surgeon. Patients were selected for FTSG nasal reconstruction if there was sufficient soft tissue present in the base of the defect and the perichondrium had not been violated. All FTSGs were harvested from the forehead near the hairline in the “widow’s peak”area. All skin grafts were thinned of subcutaneous fat then sutured to the defect with quilting sutures in order to prevent fluid collections. Xeroform was then bolstered onto the defect . Patients were then followed to observe FTSG take and aesthetic outcomes.
Results:
20 patients were included in this case series. 60% of patients were male and the average age of patients was 74.27 years. Most of the patients had nasal tip reconstruction (N=12). Others had nasal dorsum (N=2), nasal side wall (N=1) and alar reconstruction (N=2). Average size of the lesion with margins excised was 1.69 cm (range 0.5-4.5cm). Patients were followed post-operatively until their surgical site was fully healed. Most patients had satisfactory results in which color, texture, and skin thickness match were excellent, as demonstrated in figures 1-5.
Conclusion:
In our case series we demonstrate that FTSG from the forehead is a viable alternative to local and regional flaps for nasal reconstruction. FTSGs restore adequate nasal contour, texture and color while also minimizing donor site morbidity. The forehead donor site also provides improved outcomes in regard to color, contour and thickness match when compared to traditionally used periauricular FTSGs.
