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

Abstract

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. 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. 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 6weeks postoperatively and at 1year. There were 186 cases in total in 181 patients (88 men and 93 women). Their ages ranged from 31 to 88years with a mean of 65years (median 66). Defect size varied from 0·3×0·4cm to 2·0×2·7cm, with the average defect size measuring 1·0-1·2cm 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. 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.