Reconstructive surgery is the foundation of all plastic surgery. Most of the true advances in plastic surgery have evolved from pioneering work in the reconstructive arena. This scientific paper focuses on the delicate skin of the nose and when skin grafting is an appropriate option. Dr. Constantine is a true artist and this paper really showcases his deep scientific underpinning and core dedication to helping people.
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.
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.
Good aesthetic results, based on preoperative and postoperative pho- tographic 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.
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 con- sideration 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 derm- abrasion of the graft provides a critical step for obtaining final aesthetic contour and color. (Plast. Reconstr. Surg. 124: 826, 2009.)