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Lower Third Nasal Reconstruction: When Is Skin Grafting an Appropriate Option?

McCluskey, Paul D. M.D.; Constantine, Fadi C. M.D.; Thornton, James F. M.D.

Plastic and Reconstructive Surgery: September 2009 - Volume 124 - Issue 3 - p 826-835
doi: 10.1097/PRS.0b013e3181b03749
Reconstructive: Head and Neck: Original Articles

Background: A full-thickness skin graft is generally not considered the ideal replacement for the thick, sebaceous skin of the nasal tip, ala, lower sidewalls, or dorsum. Instead, many clinicians prefer to reconstruct these defects with local or axial composite flaps that incorporate skin, subcutaneous tissue, and fat.

Methods: The authors conducted a retrospective analysis of 55 consecutive patients who underwent reconstruction of lower third nasal defects with full-thickness skin grafts between 2002 and 2007 performed by the senior author (J.F.T.). All of the patients in this review underwent skin cancer ablation by means of Mohs’ micrographic surgery.

Results: Good aesthetic results, based on preoperative and postoperative photographic analysis of contour and pigmentation, have been achieved in both the recipient and donor sites in 52 of 55 patients. Three patients, all of whom were smokers, experienced loss of the skin graft requiring alternative reconstructive techniques.

Conclusions: Under certain conditions, skin grafting of defects of the caudal third of the nose offers a viable reconstructive option that yields good contour and color match. Careful analysis of defect size, location, and depth and consideration of donor-site skin thickness and pigmentation are vital for accurate replacement of the thick, pitted, sebaceous skin of the caudal nose. An evolution in technique has revealed that the forehead donor skin often provides a more consistent color and contour match in such reconstructions. Secondary dermabrasion of the graft provides a critical step for obtaining final aesthetic contour and color.

Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication April 28, 2008; accepted March 12, 2009.

Presented at the Texas Society of Plastic Surgeons Annual Meeting, in Austin, Texas, September of 2007.

Disclosure: None of the authors has any commercial association or financial relationships that might pose or create a conflict of interest with the information presented in this article.

James F. Thornton, M.D.; Department of Plastic Surgery; University of Texas Southwestern Medical School; 1801 Inwood Road, 4th Floor; Dallas, Texas 75390-9132;

©2009American Society of Plastic Surgeons